Presence Of Comorbid Diseases Research Articles

Labilization of the DNA structure in peripheral blood lymphocytes of COVID-19 patients

Introduction. Available data indicate the SARS-CoV-2 coronavirus to be potent of impairing DNA repair processes and cause oxidative stress, which can lead to the accumulation of DNA damage in human cells. However, the DNA-damaging effect of the virus has not yet been sufficiently studied. The purpose of the research was to study the ability of SARS-CoV-2 to cause DNA damage in human peripheral blood lymphocytes. Materials and methods. One hundred forty COVID-19 patients and 24 donors of the control group are included in the study. The level of DNA fragmentation in lymphocytes was determined by alkaline DNA-comet assay. Statistical differences between the mean medians of the «%DNA in the comet tail» (tail DNA%) were assessed using Student’s t-test. The Jeffers test was used to compare the proportions of cells with different levels of DNA-damage. Statistical differences between groups were assessed using the Mann-Whitney test. Results. In the COVID-19 patients, an increase in the level of breaks and alkali-labile sites in DNA was revealed when compared to controls (p = 0.025). In the group of patients infected with SARS-CoV-2, the proportion of comets with DNA damage of up to 5% decreased (p = 0.009), while the proportion of comets containing more than 10% DNA tail increased (p = 0.000). The number of atypical comets compared to the control increased by 3.7 and 5.9 times with mild and moderate severity of the disease, respectively (r = 0.993; p = 0.001). In the association with diseases – coronary heart disease (CHD) and diabetes mellitus type II (DM type 2), the level of DNA fragmentation in lymphocytes statistically significantly increased compared to the group of patients without these diseases. Limitations. A limitation is the lack of data on DNA-structure damage in severe COVID-19 disease. Conclusion. SARS-CoV-2 infection leads to labilization of the DNA structure in human peripheral blood lymphocytes. The level of DNA damage depends on the severity of COVID-19 and the presence of comorbid diseases: CHD and DM type 2. The results of the study are important for understanding the mechanisms of action of the virus on human immunocompetent cells.

Gambaran Prinsip Good Governance dalam Kebijakan Gerakan Masyarakat Hidup Sehat

The presence of comorbid diseases has become a crucial concern in confronting the COVID-19 pandemic, underscoring the need for the implementation of GERMAS (Healthy Living Movement) policy as a preventive measure initiated by the government. GERMAS aims to control the increase in non-communicable disease cases, which have the potential to disrupt human resources and productivity, as well as negatively impact social and economic development. In its implementation, GERMAS must adhere to the principles of Good Governance to ensure transparency, community participation, accountability, effectiveness, efficiency, responsiveness, and consensus. This research aims to analyze Transparency, Participation, Accountability, Effectiveness and Efficiency, Responsiveness, and Consensus. This research employs a qualitative approach with a narrative method and in-depth interviews with 12 informants. While GERMAS has been implemented since the President's directive in 2017, there are still several challenges in enhancing its effectiveness. Analysis of Good Governance principles highlights issues such as lack of community participation, low transparency and inter-agency coordination, and insufficient attention to inactive GERMAS forums. Further research is needed to deepen understanding of GERMAS implementation in Kutai Barat, focusing on aspects such as inter-sectoral communication, community participation, and enhancement of accountability of relevant agencies. Concrete steps such as comprehensive performance audits and increased social media outreach can help improve policy implementation.

Therapy of moderate-to-severe plaque psoriasis

Psoriasis therapy is an acute issue in modern medicine. To date, much progress has been made in the field of genetically engineered biological therapy (GEBT) for psoriatic disease. The new treatment paradigm was made possible by the continuous advancement of understanding of the pathophysiology of the disease. GEBT represents an evolved treatment regimen in which targeted immunomodulation has led to significant improvements in the safety and efficacy of biological agents. Understanding the key role of interleukin-23 (IL) in the pathogenesis of psoriasis has led to the development of new drugs. Risankizumab is a humanised monoclonal antibody – immunoglobulin class G1 – specifically targeted at cytokine IL-23 inhibition by binding to its subunit p19. The efficacy and safety of the agent have been demonstrated both by the results of clinical trials and studies of real clinical practice. The article presents key data on the applicability of the drug risankizumab, and describes the clinical experience of managing a patient with psoriasis and aggravated comorbid conditions. It is currently known that a significant problem in the management of patients receiving GEBT is the presence of comorbid diseases. Difficulty in optimal treatment control, decreased response to therapy and increased risks of adverse events have all been noted. This study confirms the efficacy and safety of risankizumab therapy in patients with psoriasis and comorbidities. Thus, risankizumab is a promising drug for the treatment of moderate and severe forms of psoriasis, its use can significantly improve the quality of life of patients suffering from this disease.

Is LigaSure Alone Sufficient for the Closure of the Appendix Stump?

Closure of the appendix stump is necessary for laparoscopic appendectomy. Problems that occur during the appendix stump closure can cause severe morbidity. Several methods of stump closure have been described. This study aimed to investigate the adequacy of LigaSure alone in closing the appendix stump. Patients who were operated on with the diagnosis of acute appendicitis between October 2021 and January 2022 were evaluated retrospectively. The patients were divided into two groups according to the closure technique of the appendix stump hemoclip(group I) and LigaSure only(group II). In addition, demographic data (age, gender), body mass index (BMI), presence of comorbid disease, perioperative appendicitis classification, operation time, postoperative hospital stay, radiological and pathological appendix size of the patients included in the study were recorded. Clavien Dindo was used for postoperative complication assessment. The study included 77 patients. 48(62.3%) of the patients were in group I, and 29(37.7%) were in group II. There was no statistical difference between the groups regarding age, gender distribution, BMI, presence of comorbid disease (P > .05). The operation time of group I was longer than group II (P < .001). There was no difference between the groups in terms of both radiological and pathological appendix size. There was no statistical difference between the groups regarding postoperative complications and severity of complications (P = .76, P = .99, respectively). Appendiceal stump closure can be performed with Ligasure, but it should be noted that this procedure can be performed on selected patients, as in the study group, not on all patients.

Effect of pulse methylprednisolone on prognosis in SARS-CoV-2 patients with severe pneumonia.

This study aimed to evaluate the effect of pulse methylprednisolone treatment on prognosis in severe COVID-19 pneumonia. This retrospective cohort study included 128 patients hospitalized in our clinic for severe COVID-19 between March 2020 and February 2021. Standard treatment (plaquenil, favipravir, low molecular weight heparin, and antibiotics when necessary) was given to the patients in accordance with the Turkish Ministry of Health guidelines. After steroid treatment was included in the guidelines, dexamethasone 6 mg/day was administered along with standard treatment. In patients whose clinical condition did not improve despite this treatment, 250 mg/day methylprednisolone (pulse steroid therapy) was administered intravenous (i.v.) for 3 days, followed by a 40 mg/day maintenance dose. The group receiving methylprednisolone 250 mg/day for 3 days and the group receiving standard treatment without steroids were compared in terms of symptoms, comorbidities, laboratory and radiological findings, length of hospitalization, prognosis, intensive care unit (ICU) admission, and intubation. Of the 128 patients included in the study, 85 (66.4%) were male, and the mean age was 61.7 ± 13.2 years (min: 25; max: 88). A total of 50 (39.1%) patients were transferred to the ICU, while the number of intubated patients was 37 (28.9%). Pulse methylprednisolone treatment was given to 98 (76.6%) patients, compared to the 30 (23.4%) patients who received only standard treatment. In total, 37 patients (28.9%) died. The presence of comorbid diseases (34.3% vs. 1.5%, p = 0.012), advanced age (67.7 vs. 59.3, p = 0.001), and not receiving steroid treatment (p = 0.046) significantly increased mortality. The mortality rate was 24.4% (24/98 patients) in the steroid therapy group and 43.3% (13/30 patients) in patients not receiving steroid therapy, and the difference was statistically significant (p = 0.046). Pulse steroid therapy also significantly decreased the rate of intubation (p = 0.014) and ICU admission (p = 0.007). In the logistic regression analysis that included comorbidity, advanced age, and pulse steroid therapy, advanced age (p = 0.022) and pulse steroid therapy (p = 0.048) were found to be effective independent variables of mortality. The results showed that pulse i.v. methylprednisolone significantly reduced mortality in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) patients with severe pneumonia requiring hospitalization, in addition to significantly reducing the need for intensive care and intubation. In SARS-CoV-2 patients with severe pneumonia, pulse i.v. methylprednisolone may be useful as a standard treatment in patients who do not respond to dexamethasone.

Vitamin D Deficiency and Receptor Polymorphisms as Risk Factors for COVID-19

Background: Early immune responses to COVID-19 can help eliminate the virus; therefore, strategies to improve the immune system have become important in disease prevention. Vitamin D plays a crucial role in the immune response to SARS-CoV-2 by increasing the expression of the vitamin D receptor. Objectives: This study investigated the impact of vitamin D deficiency, Fok 1, and Taq 1 Vitamin D Receptor (VDR) gene polymorphisms and comorbidities on the susceptibility to COVID-19. Methods: Fok1 and Taq1 polymorphisms were analyzed using the RT-PCR method, and vitamin D levels were measured using the chemiluminescence method. A total of 200 patients, 100 with COVID-19 and 100 without, provided blood samples for analysis. Results: The COVID-19 positive group had a significantly lower mean vitamin D level of 16.2 ± 11.3 ng/mL compared to the COVID-19 negative control group, 26.7 ± 15.9 ng/mL (P &lt; 0.001). Individuals with a vitamin D level below 18.4 ng/mL had a 2.448 times higher risk of COVID-19 positivity (P &lt; 0.001). There was no significant difference in the Fok1 and Taq1 gene polymorphisms between the two groups. (P = 0.548 and P = 0.098). The COVID-19 positive group had a significantly higher number of comorbid diseases with 40 (40%) compared to the negative group with 10 (10%) participants (P &lt; 0.001). Conclusions: Levels of vitamin D above the cut-off value of 18.4 ng/mL were found to protect against COVID-19, while the presence of comorbid diseases was identified as a risk factor. However, no association was observed between the Fok1 and Taq1 polymorphisms and susceptibility to COVID-19.

Postoperative Cognitive Dysfunction: Mechanism and Prevention

Postoperative cognitive dysfunction (POCD) refers to a condition characterized by impaired cognitive processing and reasoning, which can negatively affect perceptual abilities and play a crucial role in overall health. Factors such as age, educational attainment, history of mental illness, and the presence of comorbid diseases can influence the occurrence of postoperative cognitive dysfunction (POCD). Strategies aimed at preventing the occurrence of postoperative cognitive dysfunction (POCD) involve both surgical interventions and addressing patient-related issues, as well as optimizing the administration of anesthetics and conducting surgery in a stress-free manner. The benefits of reducing oxidative stress and inflammation in brain cells have been demonstrated. Postoperative recovery may be extended due to postoperative cognitive dysfunction (POCD). The studies conducted showed heterogeneity in terms of patient groups, methodology used to quantify POCD, and study design, making it challenging to draw generalizable conclusions. The prevalence of postoperative cognitive dysfunction (POCD) is a widespread health concern globally.

Demographic and Clinical Characteristics of Earthquake Victims Presented to the Emergency Department with and without Crush Injury upon the 2023 Kahramanmaraş (Turkey) Earthquake.

Earthquakes are sudden-onset natural disasters that are associated with substantial material damage, resulting in the collapse of built environment with a high rate of mortality, injury, and disability. Crush syndrome, which can be seen after devastating earthquakes, can lead to acute kidney injury (AKI) and patients may require amputation, fasciotomy, and dialysis. Supportive treatment has an important role in the prognosis of these patients. The aim of this study was to investigate the demographic and clinical characteristics of traumatic earthquake survivors admitted to the emergency department (ED) of a hospital, which was close to the earthquake zone but not affected by the earthquake, after the February 6, 2023 Kahramanmaraş (Turkey) earthquakes. This study was conducted by retrospectively analyzing the data of 1,110 traumatized earthquake survivors admitted to the ED of a tertiary care university hospital from February 6th through February 20th, 2023. Age; gender; time of presentation; presence of comorbid diseases; ED triage category; duration of stay under debris; presence of additional trauma; laboratory tests; presence of AKI; presence of crush injury and injury sites; supportive treatment (fluid replacement and intravenous [IV] sodium bicarbonate); need for amputation, dialysis, and fasciotomy; duration of hospitalization; and outcome of ED were evaluated. Of the 1,110 traumatic victims in this study, 55.5% were female patients. The mean age of the patients was 45.94 (SD = 16.7) years; the youngest was 18 years old and the oldest was 95 years old. Crush injury was detected in 18.8% and AKI in 3.0% of the patients. Dialysis, amputation, and fasciotomy were required in 1.6%, 2.8%, and 1.4% of the patients, respectively. In total, 29.2% of patients were hospitalized, including 2.9% admitted to the intensive care unit (ICU) and 26.3% to the relevant ward. In total, 0.3% of the patients included in the study died at ED. Post-earthquake patients may present with crush injury, AKI may develop, and fasciotomy, amputation, and dialysis may be needed, so hospitals and EDs should be prepared for natural disasters such as earthquakes.

Some aspects of diagnosis, course and prediction of outcomes of a new coronavirus infection in patients with diabetes mellitus

Introduction. By 2023 it has been detected more than 600 million cases of COVID-19. One of the most significant risk factors for the severe course of a new coronavirus infection (NCVI) is the presence of comorbid diseases, especially the presence of diabetes mellitus (DM).Aim. To investigate the laboratory and clinical features of a new coronavirus infection in people with diabetes mellitus, to identify predictors of an adverse outcome of COVID-19.Material and methods. We carried out data from medical records of 248 patients treated in “Voronezh Clinical Emergency Hospital № 10” in the departments “COVID-5” and “COVID-8”. Data collection and statistical processing were performed with Microsoft Excel 10.0 and StatSoft STATISTICA 12.0 programs.Results. The most frequent complaints of patients were general weakness, hyperthermia and dry cough. The analysis of the age characteristics revealed that the peak incidence of NCVI in hospitalized patients without DM falls on 70-79 years, with concomitant DM — on 60-69 years.Among comorbid pathologies, hypertension, coronary heart disease and chronic heart failure prevailed. The presence of these diseases is a predictor of adverse outcomes in NCVI, along with cerebrovascular diseases and anemia.Evaluation of laboratory data revealed the link of elevated levels of ferritin, C-reactive protein and D-dimer with an increased risk of death of NCVI.Conclusion. Estimation the risk factors of a fatal outcome is crucial for the choice of patient treatment tactics.

Safety and effectiveness of laparoscopic appendectomy in patients undergoing abdominal surgery

Abstract Background Although laparoscopic appendectomy is the criterion-standard treatment method for acute appendicitis, the decision on laparoscopic or conventional technique is usually made according to individual perspectives. The reasons affecting this individual point of view include whether the disease is complicated, the infrastructure of the hospital, the patient's comorbid factors, and previous intra-abdominal operations. This cross-sectional retrospective study aimed to evaluate the safety of laparoscopic appendectomy in patients with a possible diagnosis of “appendicitis” in patients who had undergone previous abdominal surgery. Methods Patients who were operated on with the diagnosis of acute appendicitis in our clinic between March 2021 and March 2022 were retrospectively analyzed. Patients were grouped as those with a history of abdominal surgery (group 1) and without (group 2). In addition, demographic data of the patients (age, sex), body mass index, presence of comorbid disease, history of abdominal surgery, operation time, rate of conversion to open surgery, postoperative hospital stay, complications, and radiological and pathological appendix size were recorded. Results A total of 181 patients were included in the study. The mean age was 32.51 ± 15.89 years. Seventy (38.7%) of the patients were female, and 111 (61.3%) were male. Thirty-four patients (18.8%) were in group 1, and 111 patients (81.2%) were in group 2. The mean age, body mass index, and operation time in group 1 were statistically higher than in group 2 (P &lt; 0.001). However, there was no difference between the groups regarding postoperative hospital stay, radiological and pathological appendix size, conversion to open surgery, and presence and severity of complications (P &gt; 0.05). Conclusion In line with the data the authors have shown in their study, a laparoscopic appendectomy can be performed safely in patients who have undergone abdominal surgery. Therefore, surgeons should not stray from a laparoscopic appendectomy when they see an abdominal incision.

Assessing survival time of outpatients with cervical cancer: at the university of Gondar referral hospital using the Bayesian approach

BackgroundCervical cancer is the 4th most common cancer in women worldwide. as well as the 4th most common cause of cancer-related death. The main objective of this study was to identify factors that affect the survival time of outpatients with cervical cancer.MethodsA retrolective study including outpatients with cervical cancer was carried out in a hospital. To achieve the aim, 322 outpatients with cervical cancer were included in the study based on the data taken from the medical records of patients enrolled from May 15, 2018, to May 15, 2022, at the University of Gondar referral hospital, Gondar, Ethiopia. The Kaplan–Meier plots and log-rank test were used for the comparison of survival functions; the Cox-PH model and Bayesian parametric survival models were used to analyze the survival times of outpatients with cervical cancer. Integrated nested Laplace approximation methods have been applied.ResultsOut of a total of 322 patients, 118 (36.6%) died as outpatients. The estimated median survival time for patients was 42 months. Using model selection criteria, the Bayesian log-normal accelerated failure time model was found to be appropriate. According to the results of this model, oral contraceptive use, HIV, stage, grade, co-morbid disease, history of abortion, weight, histology type, FIGO stage, radiation, chemotherapy, LVSI, metastatic number, regional nodes examined, and tumor size all have a significant impact on the survival time of outpatients with cervical cancer. The Bayesian log-normal accelerated failure time model accurately predicted the survival time of cervical cancer outpatients.ConclusionsThe findings of this study suggested that reductions in weight, treatment, the presence of comorbid disease, the presence of HIV, squamous cell histology type, having a history of abortion, oral contraceptive use, a large tumor size, an increase in the International Federation of Gynecologists and Obstetricians stage, an increase in metastasis number, an increase in grade, positive regional nodes, lymphatic vascular space invasion, and late stages of cancer all shortened the survival time of cervical cancer outpatients.

The investigation of host genetic variants of toll-like receptor 7 and 8 in COVID-19

Toll-like receptors (TLRs) recognize infectious agents and play an important role in the innate immune system. Studies have suggested that TLR single nucleotide polymorphisms (SNPs) are associated with poor antiviral responses against SARS-CoV-2. Therefore, we aimed to investigate the relationship of TLR7 and TLR8 (SNPs) with COVID-19 disease prognosis. A total of 120 COVID-19 patients, 40 outpatients, 40 clinical ward patients and 40 intensive care unit (ICU) patients were included in the study. TLR7 (rs179009), TLR8-129 C/G (rs3764879) and TLR8 Met1Val (rs3764880) SNPs were genotyped using the PCR-RFLP method. In female patients, individuals carrying AG genotype and G allele for TLR8 Met1Val SNP were found at a higher frequency in patients hospitalized in the ICU than in patients followed in the clinical ward (p < 0.05). In terms of the other two SNPs, no significant difference was found between the groups in females. Furthermore, in male patients, A allele of TLR7 rs179009 SNP was at a higher frequency in patients who have at least one comorbidity than in patients who have no comorbidity (p < 0.05). Our results suggest that TLR8 Met1Val SNP is important in the COVID-19 disease severity in females. Furthermore, TLR7 rs179009 SNP is important in male patients in the presence of comorbid diseases.

Methods of assessing the quality of life in women with malignant neoplasms of the reproductive system

HAC (Russian) RSCI (Russian) EBSCO DOI (USA) Ulrichsweb (Ulrich’s Periodicals Directory) Scientific Indexing Services Methods of assessing the quality of life in women with malignant neoplasms of the reproductive system Primary tabs View(active tab) Edit Manage display Translate DOI: https://doi.org/10.29296/25877305-2023-01-02 Issue: 1 Year: 2023 Professor A. Solopova(1), MD; D. Blinov(1–3), Candidate of Medical Sciences; Professor E. Achkasov(1),MD; L. Sandzhieva(1), D. Korabelnikov(3), Candidate of Medical Sciences; G. Bykovshchenko(1), D. Petrenko(1), 1-I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia 2-Institute of Preventive and Social Medicine, Moscow 3-F.P. Haass Moscow Medical and Social Institute The growth of malignant neoplasms of the female reproductive system in recent years has acquired a tendency to "rejuvenation" – more frequent appearance in women of reproductive age. Radical methods of treating pathologies of the oncogynecological spectrum leave severe consequences in the form of genitourinary syndrome, disorders of endocrine-metabolic processes, sexual function, unstable psychological state, social maladaptation and a decrease in the quality of life. To restore the effects of antitumor treatment, a comprehensive rehabilitation is required, developed by a multidisciplinary team of specialists, including questionnaires on the quality of life. Numerous studies have shown the effectiveness of questionnaires FACT-G, FACT-En, EORTC, FSFI, HADS, the health, activity, mood questionnaire, modified Kupperman–Uvarova menopausal index, MDQ, magnesium deficiency assessment test, stress tolerance self-assessment test. These questionnaires allow us to assess the patient's condition in a timely manner, his perception of his own quality of life and the presence of comorbid diseases and conditions. The introduction of questionnaires into routine clinical practice will make it possible to more effectively carry out rehabilitation measures in oncogynecological patients.

Chronic recurrent wheals - If not chronic spontaneous urticaria, what else?

Chronic urticarial rash, mostly due to chronic spontaneous urticaria (CSU), is seen in up to 1-4% of the general population. Urticarial vasculitis (UV) and autoinflammatory syndromes, i.e., cryopyrin-associated periodic syndromes (CAPS) and Schnitzler syndrome (SchS), can mimic CSU-like rash but represent rare disorders with systemic symptoms including fever, headache, conjunctivitis, and arthralgia. Clinical and laboratory features can point to the presence of any of these diseases in patients initially presenting with chronic urticarial rash. These include long-lasting wheals (> 24 hours), lesional burning, systemic symptoms, and/or increase in inflammatory markers (e.g., C-reactive protein, serum amyloid A, and/or S100A8/9). Lesional skin biopsy usually demonstrates leukocytoclastic vasculitis (UV) or neutrophil-rich infiltrate (CAPS and SchS). In contrast to CSU, where second-generation H1 antihistamines and omalizumab allow to control symptoms in most patients, systemic immunosuppression and anti-interleukin (IL)-1 therapies are needed in case of UV and autoinflammatory diseases, respectively. The rarity and low awareness of CSU differential diagnoses may be related to the longer delays in diagnosis and therapy in those affected with UV, CAPS, and SchS. Knowledge of the differential diagnoses of CSU is important because only correct diagnosis allows adequate therapy. Complications such as the development of lymphoproliferative disease in SchS and amyloidosis in CAPS, and the presence of comorbid diseases, such as systemic lupus erythematosus in UV, must be considered and monitored.

Quality of Life among Ethiopian Cancer Patients: A Systematic Review of Literatures.

Assessment of quality of life (QoL) in cancer patients can provide an overall picture of the patient's adaptation to the disease and maintain long-term health and well-being. Determining the QoL in cancer patients could help with better care and could be as prognostic as medical factors and the survival benefit that pharmacological treatment could provide. The main objective of this review was to determine the prevalence of QoL among Ethiopian adult cancer patients. A systematic review was conducted using the "Preferred Reporting Results of Systematic Reviews and Meta-Analyses" guidelines. Databases such as PubMed/Medline, CINAHL, AMED, Embase, the Cochrane Library, ScienceDirect, World Health Organization's Hinari portal, and African Journals Online databases were searched from January 2022 to June 2022. Google, Google Scholar, and university repositories were used to access unpublished studies. Two reviewers independently screened the data using a standardized data extraction format and appraised their quality using the Newcastle-Ottawa Scale. In this review, 10 studies were included. The prevalence of poor QoL ranged from 52 to 89.6. The physical, role, social, and emotional functioning were the most affected domains of QoL and have been significantly associated with QoL. Financial difficulty was the most important predictor of QoL among Ethiopian cancer patients. Pain, dyspnea, nausea, vomiting, and poor appetite were also reported as predictors of QoL. Low income, lower educational status, unmarried status, underweight, anxiety, and depression, advanced stage of cancer, patients with ≤2 cycles of chemotherapy, and the presence of comorbid diseases were significantly correlated with QoL. The QoL of an Ethiopian cancer patient was low. Quality of life assessments, appropriate symptom management, integration of psycho-oncology care, and providing economic support shall be considered to improve their QoL.

Factors predicting pathological complete response to neoadjuvant chemotherapy in patients diagnosed with non-metastatic muscle invasive urothelial bladder cancer

Aim: In this study, we aimed to investigate the factors that may have the potential to predict pathological complete response (pCR) with platinum-based neoadjuvant chemotherapy (NAC) in non-metastatic muscle-invasive bladder cancer (MIBC).Methods: Our study included 46 patients diagnosed with non-metastatic MIBC, who applied to Dicle University Medical Oncology Clinic between 2016-2019 years and received NAC. Age, gender, ECOG performance score, tumor grade, pathological tumor (pT) stage, clinical lymph node (cN) status, localization of the primary tumor in the bladder, presence of comorbid diseases, renal failure status, hydronephrosis, and NAC regimens were analyzed.Results: Of the total 46 patients included in the study, 42 (81.3%) were male and 4 (8.7%) were female. The median age at diagnosis was 61.5 (34-77) years. In the group of patients aged

Correlation of Patient Features of Covid-19, Laboratory Tests and Computed Tomography Findings: Single-Center Retrospective Study

Aim: Computed Tomography (CT) findings, clinical and laboratory data are very important in the diagnosis and treatment process of Coronavirus Disease 2019 (COVID-19). In this study, the relationship between these findings was investigated. Material and method: 93 patients with positive Reverse-Transcriptase Polymerase Chain Reaction (RT-PCR) test for SARS-CoV-2 were included in the study. CT findings, laboratory tests, and the World Health Organization Clinical Progress Scale (WHO-CPS) were evaluated. Results: Of the patients, 52 were male and 41 were female. The mean age was 46. The most common laboratory finding is high CRP levels (67.74%). GGO, consolidation, halo sign and air bronchogram were most frequent CT findings. The mean of CT score was 4.91. A statistically significant positive correlation was found between CT score and age, D-dimer, CRP, ferritin and fibrinogen. There was a significant negative correlation between CT score, lymphocyte count and oxygen saturation. There was no correlation between CT score and procalcitonin, gender and presence of comorbid disease. There was a moderate negative correlation between CT score and IL-6 blocker use and corticosteroid therapy, and a mild negative correlation between CT score and favipravir use. The correlation between CT score and immunosuppressant use was not significant. We also found a moderate positive correlation between WHO-CPS and CT scores. Conclusion: The CT score is correlated with some laboratory and clinical markers, and we think that these findings indicate that CT is a very useful test in the diagnosis as well as in the follow-up.

COVID-19 clinical findings of patients: Tertiary care hospital in Turkey

Aim: The aim of this study is to evaluate the clinical findings of patients (15±84 years) in the course of COVID-19 with the experience of a tertiary hospital. Materials and methods: The study included a group of 407 (Female: X; Male: Y) patients with symptoms of COVID-19 who have followed up in the Malatya Research and Training Hospital Department Outpatient Clinic of COVID-19 between 23 October, 2020 - 29 December, 2020. Results: According to the results, the most common signs/symptoms in patients were fever at 25.1%, nausea at 15% and diarrhea at 11.5%, chronic disease history in patients, 28.7% HT, 17.9% tachycardia, and 16.5% asthma. In addition, in the distribution of the patients regarding contact detection, it was determined that 53.8% were contacted, 44.2% were non-contact, and 2% were Viral Capsid Antigen (VCA). Conclusions: The most common clinical manifestations of COVID-19 infection are fever, dry cough, and shortness of breath. Sore throat, myalgia, headache, and fatigue may follow these symptoms. Gastrointestinal symptoms such as nausea and diarrhea, as well as anosmia, or loss of taste, might be observed on a rare frequency. The presence of comorbid diseases and advanced age both contribute to the worsening of the clinical picture. It has the potential to evolve into clinical ARDS. Clinical findings, in addition to laboratory and radiological data, are critical in determining possible and definitive case definitions. Keywords : Course of COVID-19-disease,COVID-19,viral infection,symptom

The role of laparoscopic modified antireflux monoanastomotic gastric bypass in the treatment of morbid obesity

Aim. Improving the results of surgical treatment for patients with morbid obesity by evaluating the effectiveness and comparing the results of bariatric operations, namely laparoscopic modified monoanastomotic gastric bypass (LMMGB) and laparoscopic standard Roux-en-Y.Materials and methods. The work analyzed the results of treatment of 41 patients with morbid obesity. All patients were divided into two groups. LMMGB surgery was performed for 30 patients (the main group). The control group consisted of 11 patients after the standard technique of laparoscopic standard Roux-en-Y. Inclusion criteria were: persons of both sexes aged 18–60 years with morbid obesity and body mass index of 40 kg/m2 or more, as well as 35 kg/m2 or more in the presence of comorbid diseases (type 2 diabetes, hypertension, dyslipidemia, sleep apnea syndrome). Body weight of the patients ranged from 83 kg to 173 kg. The average body mass index was 42.5 kg/m2 in the main group before the operation. Violation of carbohydrate metabolism, which is included in the criteria of metabolic syndrome, was detected in 28 (93.33 %) of 30 studied patients of the main group and in 10 (90.90 %) of 11 studied patients of the control group. Comorbid pathology was found in 76.67 % of the main group and 72.72 % of the control group.Statistical processing was carried out via the Statistica 13.0 software package using parametric and non-parametric statistical methods.Results. There were no deaths, anastomosis failures, conversions, and intraoperative complications. The duration of LMMGB operation ranged from 120 to 290 minutes. The postoperative period was 5 days in the main group and 7 days in the control group, that is, a statistically significant reduction in the postoperative period duration was observed. In both groups, a decrease in body weight ranged from 12 kg to 81 kg within 6 months. In the main group, the median weight loss was 26.0 kg after 6 months and 38.5 kg after 12 months. BMI was 31.25 kg/m2 after 6 months, 26.88 kg/m2 after 12 months. In the control group, this indicator was 28.0 kg after 6 months and 42.0 kg after 12 months. Median BMI after 6 months – 31.64 kg/m2, after 12 months – 26.03 kg/m2, respectively. After the operation, there was a tendency towards an increase in all indicators of quality of life, both in the group of patients who underwent gastric bypass according to the classic Roux technique and in the group of patients after LMMGB. Clinical manifestations of the enterogastric biliary reflex were detected in both groups, in addition, clinical manifestations of the corresponding symptoms were noted by patients of both groups. No statistically significant difference was found in these parameters.Conclusions. Monoanastomotic gastric bypass in the modification of the clinic has the same positive properties as the standard Roux-en-Y technique, allowing to avoid the risks associated with possible pathological reflux of bile into the esophagus. Patients who have undergone a mini-gastric bypass surgery need a thorough examination with fibrogastroscopy in combination with pH-impedance measurement at least once a year in order to determine biliary reflux and morphological changes both in the lumen of the esophagus and in the stump of the stomach. The quality of life level does not significantly differ after surgery between patients of the control group and the main group based on the results of the GERG-Questionnaire indicating the effectiveness of the laparoscopic monoanastomotic gastric bypass technique modified in the clinic.

Isolated Appendectomy Technique Without Mesoappendix in Laparoscopic Appendectomy.

Laparoscopic appendectomy is among the most common general surgical procedures performed in developed countries. Among the most critical steps in laparoscopic appendectomy is transection of the appendix meso. This study evaluates the postoperative and economic outcomes between total mesoicular excision and isolated (traditional) appendectomy technique during appendix transsection, in line with the patients' clinicopathologic data. Patients who were operated on with the diagnosis of acute appendicits in our clinic between October 2021 and January 2022 were evaluated retrospectively. Patients were divided into 2 groups. In the first group, there is the isolated appendectomy technique in which the appendix meso is dissection from the tip of the appendix to the base of the cecum, while in the second group there is the technique in which the appendix meso is dissected from the base of the cecum. In addition, demographic data (age, sex), body mass index, presence of comorbid disease, operation time, postoperative hospital stay, health care costs, appendix size of the patients included in the study were recorded. During the study, 157 patients were included in the study. Seventy-one (45.2%) of the patients were in group 1, and 86 (54.8%) were in group 2. There was no difference between the groups regarding age, sex, body mass index, presence of comorbid disease, appendix size, and postoperative hospital stay ( P >0.05). However, operation time and health care costs were statistically higher in group 2 than in group 1 ( P =0.01). Although there was no difference in postoperative complications between the isolated appendectomy technique and the mesoicular technique, the operation time was shorter, and the operation cost was lower in the isolated appendectomy technique.