Mevlana Medical Sciences Journal Archive

ABSTRACT

Objectives: The high mortality rate of coronavirus disease 2019 (COVID-19) and insufficient bed capacity create significant challenges in emergency department management. Therefore, this study investigated whether the lactate/albumin ratio (LAR) predicts mortality in COVID-19 patients in the emergency department.

Methods: The study included 504 COVID-19 patients who were brought to the emergency department from March to August 2020. Their lactate and albumin levels, LAR, age, gender, and in-hospital mortality status were recorded. The patients were grouped by in-hospital mortality, and a statistical comparison was conducted between the groups.

Results: Of the included patients, 252(50%) were male, and the median age was 61.5(47–72.75) years. There was in-hospital mortality in 79(15.7%) patients. The median lactate and LAR values of the patients in the non-survivor group were significantly higher than those in the survivor group (lactate: 2.05 [1.5– 3.4] and 1.6 [1.2–2], respectively [p<0.001]; LAR: 0.584 [0.406–0.956] and 0.38 [0.29–0.489], respectively [p<0.001]). The mean albumin value in the non-survivor group was significantly lower than that in the survivor group (3.68±0.58 and 4.19±0.48, respectively; p<0.001). The LAR area-under-the-curve (AUC) values obtained to predict in-hospital COVID-19 mortality were higher than those for lactate (AUC of LAR and lactate: 0.730 and 0.669, respectively). The AUC value of LAR was significantly higher than the AUC value of lactate (p<0.001).

Conclusion: LAR is a moderately accurate predictor of in-hospital mortality in COVID-19 patients, and LAR was found to be a more reliable predictor than lactate levels.

Key words: COVID-19, lactate, serum albumin, in-hospital mortality

ABSTRACT

Introduction: The neonatal period includes first 28 days of life. Infant and neonatal mortality rates are considered as a favorable indicator for measuring health status of a nation. In this study, we aimed to determine mortality rates, causes and risk factors of patients were admitted in our neonatal intensive care unit in last decade. We compared the obtained results with those of other centers.

Material-Method: In this study, deceased neonates who were admitted and followed-up in Neonatal Intensive Care Unit of Konya Necmettin Erbakan University Meram Faculty of Medicine between 2010 and 2019 were evaluated. The study was formed in retrospective manner through reviewing discharge summaries and scanned patient files on the hospital’s automation system.

Results: A total of 9768 patients were admitted in our neonatal intensive care unit in the last decade, of which 491 deceased. In this study, our mortality rate in 2019 was 2.95%, while our total mortality rate was 5.02%. The leading causes of death, in descending order of frequency, were respiratory distress syndrome(RDS) (41.3%), sepsis (20.2%), and heart failure (11.6%).

Conclusion: The mortality rate in our unit was found to be 5.02%. This rate decreased up to 2.95% by 2019. Based on these rates, it is the gospel truth that, given the fact that termination of problematic pregnancies in our country and our city is not performed frequently due to sociocultural reasons, our unit may compete with the centers in developed countries.

Key words: Newborn, mortality, prematurity

ABSTRACT 

Aim: To develop a deep learning (DL) model for detection of glaucoma based on peripapillary retinal nerve fiber layer (pRNFL), ganglion cell layer (GCL), optic nerve head parameters using spectral domain optical coherence tomography (SD-OCT) and visual field parameters

Methods: 78 patient with glaucoma and 53 healthy subjects were recruited and split into training (%60) and test (%40) datasets. pRNFL, GCL, optic nerve head parameters and visual field parameters were used for the deep learning classifier. RapidMinerStudio9.2 was used for our deep learning model.

Results: In the test dataset, this deep learning system achieved an AUC of 0,817 with a sensitivity of % 96.

Conclusion: An SD-OCT and visual field based deep learning system can detect glaucomatous structural change with high sensitivity and specificity.

Key words: Glaucoma, deep learning, optical coherence tomography, artificial neural network

ABSTRACT

Aim: It was aimed to investigate whether there is a relationship between hypothalamic nutrition regulatory neuropeptides Neuropeptide Y (NPY), Orexin, pro-opiomelanocortin (POMC) and leptin levels in the emergence of obesity associated with OSAS and the weight change observed with PAP treatment.

Materials and Methods: Thirty-eight male volunteer patients aged 18-65 who were diagnosed with OSAS and planned for PAP treatment in the sleep laboratory of Chest Diseases were included in the study. Blood samples were taken from the patients after the diagnosis of OSAS and 6 months after PAP treatment. Neuropeptide levels were determined by ELISA method.

Results: Thirty-eight male patients the mean age was 47.82±1.64 years. Leptin, NPY, Orexin and POMC levels were lower and statistically significant in OSAS patients after 6 months of PAP treatment, independent of body mass index (BMI) (p>0.001).

Conclusion: We think that metabolic stability is achieved by eliminating apneas, providing oxygenation, correcting sleep fragmentation with PAP therapy, reducing the hypoxic effect and accordingly inflammation to a large extent. As a result, ensuring and encouraging the uninterrupted use of PAP devices by patients throughout the night will highlight the effectiveness of the treatment. In addition, giving diet and exercise programs while using the device will be effective in lowering BMIs for overweight patients.

Key words: CPAP, leptin, NPY, POMC, orexin, sleep apnea

ABSTRACT

Aim: SARS-CoV-2 is the cause of a pandemic with high mortality rates affecting the entire world. In the present study, N/L Ratios, CRP, and D-dimer levels were investigated in patients who were diagnosed with RT-PCR+ Covid-19 again despite receiving the Biontech and Sinovac vaccines.

Materials and Methods: The retrospective study was conducted with a total of 114 patients (n=114) and a healthy control group (n=60) who had 43 Biontech and 71 Sinovac vaccines but were diagnosed with RT-PCR+ Covid-19 again. Subjects who were vaccinated with Biontech or Sinovac and whose RT-PCR Test (Real-Time Polymerized Chain Reaction) was positive were included in the study. The routine biochemistry, serology, and hormone test results of the patients were compared with those of the Control Group. The data were analyzed on the computer with the SPSS22 program.

Results: CRP, N/L, and D-dimer levels were higher in the 2 vaccinated groups at statistically significant levels when compared to the control group, but higher values were detected in the Sinovac Group (p<0.001). Albumin levels were found to be lower in the vaccinated groups when compared to the Control Group (p<0.001). Procalcitonin, AST, LDH, and lipase levels were significantly higher in the vaccinated groups when compared to the Control Group, while lymphocyte levels were lower in the vaccinated groups (p<0.001).

Conclusion: Although N/L ratios, CRP, and D-dimer levels were higher in the Sinovac vaccine group than in the Control Group, albumin levels were lower in patients who were diagnosed with RT-PCR+ Covid-19 again despite having Biontech and Sinovac vaccines.

Key words: Covid-19; Biontech; Sinovac; N/L, CRP, D-dimer

ABSTRACT 
Angioedema; It is a self-limiting, localized swelling of subcutaneous or submucosal tissues resulting from extravasation of plasma fluid into interstitial tissues. Angioedema can occur as mast cell mediated, bradykinin mediated and idiopathic. The most important feature of mast cells that distinguish them from other cells of the immune system is that they have a large number of granules in their cytoplasm. With the stimulation of mast cells by various allergens (drugs, venom, latex, foods, radiocontrast substances, etc.), these granules in storage and newly produced mediators are released into the circulation. It is important to distinguish mast cell mediated angioedema from bradykinin mediated angioedema. Mast cell angioedema responds to glucocorticoid, antihistamine and adrenaline treatment. In this review, the clinical features, pathophysiology, diagnosis, differential diagnosis and treatment modalities of mast cell mediated angioedema are discussed.
 Key words: Angioedema, mast cell, histamine

ABSTRACT

Choledochal cyst and cholangitis in premature babies are rare. Choledochalcyst, which is characterized by jaundice, mass and pain complaints, can be over looked because it is rare in the neonatal period. Complications are more severe. We wanted to present you a new born case who developed a choledochal cyst and cholangitis.

Key words: Choledochalcyst,cholangitis, newborn.

ABSTRACT

Behçet's Disease (BD) is a rare autoimmune vasculitic disease that presents in many clinical conditions. While oral and genital ulcers are the most common clinical presentation, superior vena cava involvement is not common. A 38-year-old male patient was admitted to the emergency department with swelling in the face and neck that had been increasing for a few days. Bilateral internal jugular vein thrombosis was detected with Doppler ultrasonography. The patient, who had no known disease history except recurrent oral aphthae, was transferred to cardiovascular surgery due to considered Lemierre Syndrome. The patient, who developed genital ulcer during follow-up, was diagnosed with BD. We presented it because there are only a few similar cases in our literature review. We thought that this case would be an important example for considering connective tissue diseases in the differential diagnosis of patients whose clinical presentation is presented with thrombosis in an uncommon region.

Key words: Behçet’s disease, superior vena cava syndrome, venous thrombosis

ABSTRACT

Adrenal infarction is a very uncommon occasion however not very often seen in hypercoagulable states. Pregnancy is one of these hypercoagulation conditions. Changes in the coagulation system during pregnancy are effective in this hypercoagulation. We present a rare case of 36-week pregnant woman, without any history of previous thrombotic occasions, providing with right upper quadrant abdominal pain and ultimately diagnosed with unilateral rigt adrenal infarct.

Key words: Pregnancy, adrenal infarction, arterial embolism, adrenal gland

ABSTRACT

Ricinus communis, also known as castor oil, 'Palma christi' or African wonder tree, has a number of medicinal, industrial, and pharmaceutical uses. The toxic substances it contains can cause poisoning as a result of oral, inhalation and intravenous ingestion. We report the case a case of poisoning, Ricinus communis herb. The patient admitted to hospital with constipation and was discharged with healthy after three days of follow-up and treatment.

Key words: Castor oil, intoxication, herbal supplement