|3.||COVID-19 in Special Patient Groups|
Ayşegül İnci Sezen, Zuhal Yeşilbağ, Hayat Kumbasar Karaosmanoğlu
doi: 10.4274/csmedj.galenos.2022.2022-11-3 Pages 39 - 45
At the end of 2019, a new coronavirus was identified as the cause of many pneumonia cases in Wuhan, a city in Chinas Hubei Province. These cases spread rapidly, causing an epidemic throughout China, followed by increasing cases in other countries. In February 2020, the World Health Organization defined the definition of Coronavirus disease-2019 (COVID-19), which means 2019 coronavirus disease. The virus that causes COVID-19 is called severe acute respiratory syndrome-coronavirus-2. The rapidly expanding COVID-19 pandemic has affected all areas of daily life, including medical care. Although this epidemic significantly affected individuals from all parts of society, the clinical course, diagnosis, and treatment approaches may differ in some specific populations. The association of COVID-19 with various medical comorbidities and its impact on specific and vulnerable populations need to be addressed separately. This information will also assist in the management of COVID-19. The effects and the relationship of COVID-19 on comorbidities (chronic renal, diabetes mellitus, chronic liver, etc.) and special populations (pregnant, elderly, transplant patients, etc.) are comprehensively presented in the text.
|4.||Aortopulmonary Window: Classification, Associated Cardiac Anomalies, Treatment Options, and Clinical Outcome|
Fatma Sevinç Şengül, Perver Arslan, Pelin Ayyıldız, Erkut Öztürk, İbrahim Cansaran Tanıdır, Okan Yıldız, Sertaç Haydin, Alper Güzeltaş
doi: 10.4274/csmedj.galenos.2023.2023-5-1 Pages 46 - 52
Objective: Aortopulmonary window (APW) is an uncommon congenital cardiac abnormality marked by a septation defect between the ascending aorta and pulmonary artery. This study aimed to define the clinical characteristics, diagnostic features, treatment strategies, and follow-up outcomes of pediatric patients diagnosed with APW.
Material and Methods: We retrospectively reviewed children diagnosed with APW from 2010 to 2023. Morphological APW typing of our patients was based on the classification that is settled by the Society of Thoracic Surgeons (STS) Congenital Heart Surgery Database Committee. The patients demographic data, symptoms at admission, transthoracic echocardiography, cardiac computed tomography, management modalities, and follow-up data were evaluated.
Results: Twenty-five children were diagnosed with APW over the study period. Thirteen patients were male (52%), and the median age at presentation of the patients was three months (8 days-7.5 years). Two patients were diagnosed with coronary fistula by echocardiography at the first admission and were diagnosed with APW after catheterization. APW was detected in one patient while being operated on for large ventricular septal defect. According to the STS classification, 32% (n=8) of the patients were type III, 32% (n=8) were type I, 16% (n=4) were intermediate type, 12% (n=3) were type II, and 4% (n=1) were APW with aortic interruption. Associated cardiovascular malformations were in 76% (n=19) of the patients. Fifteen patients (60%) underwent surgery. Transcatheter closure of APW was performed in four patients (16%).
Conclusion: Detection of the APW requires careful and systematic investigation. Transcatheter closure can be performed in selected cases where the defect is suitable. Although rare, this defect, which can cause severe left-right shunting, should be kept in mind as a cause of pulmonary hypertension and unexplained cardiac dilation and should be investigated in patients whose cause cannot be determined.
|5.||Combined Use of D-dimer and NLR as a Prognostic Index in COVID-19|
Birsen Pınar Yıldız, Didem Görgün Hattatoğlu, Sariha Büyüklüoğlu, Cihan Aydın
doi: 10.4274/csmedj.galenos.2023.2023-2-1 Pages 53 - 61
Objective: We aimed to investigate the combined use of D-dimer and neutrophil-to-lymphocyte ratio (NLR) as a prognostic index-coronavirus disease (PRI-COVID) in COVID-19 patients to predict mortality.
Material and Methods: We included 152 COVID-19 patients in our cross-sectional study. The cut-off value of D-dimer to predict mortality was 1.07 μg/mL with a sensitivity of 68% and specificity of 80% [area under curve (AUC) ± SE: 0.752±0.05; positive predictive value (PPV) 39.5%, and negative predictive value (NPV) 92.7%; p<0.001]. Meanwhile, at a cut-off value of 3.83, the sensitivity and specificity of NLR in predicting mortality were 92% and 48.8%, respectively (AUC ± SE: 0.730±0.05; PPV: 26.1%; NPV: 96.9%; p<0.001). We categorized patients as low, moderate, and high risk using the PRI-COVID model (low risk: <1.07 D-dimer and <3.83 NLR; moderate risk: >1.07 D-dimer or >3.83 NLR; high risk: >1.07 D-dimer and NLR >3.83). High-risk PRI-COVID was associated with 6.37 times increased risk of death compared with the low/moderate risk group.
Results: Combined use of coagulation and inflammation parameters might can be associated with mortality.
Conclusion: Our results suggest that PRI-COVID is easy to assess and useful in predicting both 30-day and overall survival in patients with COVID-19.
|6.||COVID-19-related Secondary Bacterial Infections in Intubated Critical Illness|
Derya Tatlısuluoğlu, Gülçin Hilal Alay, Onur Özalp, Güldem Turan
doi: 10.4274/csmedj.galenos.2023.2022-12-6 Pages 62 - 67
Objective: The prevalence, occurrence, and characteristics of bacterial infection in individuals with severe acute respiratory syndrome coronavirus-2 is primarily unknown. In this research, we examined the effects of secondary bacterial infections (SBI), antibiotic use, and mortality on coronavirus disease-2019 (COVID-19) patients who were observed in intensive care units (ICU) when intubated.
Material and Methods: Between October 1, 2020 and February 1, 2021, patients who were monitored because of COVID-19 in adult ICUs at tertiary healthcare facilities were included in this retrospective research. The study included The study included a total of 170 individuals with acute respiratory distress syndrome and COVID-19 pneumonia.
Results: Antibiotics were given to 154 (90.58%) patients. While all SBI-positive patients received antibiotic treatment, 78 (45.88%) SBI-negative patients were also treated. In addition, SBI-positive patients had a higher mortality rate (p<0.001). Time-SBI was 3.13±2.42/days in patients with catheters, and it was shorter and statistically significantly different compared with patients without catheters (p<0.03). Blood culture growths were discovered in 24 (14.1%) of patients and were the most common.
Conclusion: Antibiotic-resistant microorganisms render humans more vulnerable to bacterial infections while also reducing our ability to fight viral pandemics. Preventing drug resistance and avoiding needless antibiotic treatment are two strategies that should be implemented today to prepare for future pandemics.
|7.||Magnetic Resonance Imaging Observations of Nearby Segment Deterioration in Isthmic and Degenerative Spondylolisthesis|
Özlem Elibol, Utku Adilay
doi: 10.4274/csmedj.galenos.2023.2023-4-1 Pages 68 - 77
Objective: The objective of the study was to evaluate the extent of deterioration in nearby upper and lower segments in lumbar isthmic and degenerative spondylolisthesis using magnetic resonance imaging (MRI).
Material and Methods: A retrospective evaluation was conducted on lumbar spine MRI scans of 51 individuals diagnosed with isthmic spondylolisthesis and 55 individuals diagnosed with degenerative spondylolisthesis. Adjacent intervertebral segments were evaluated for disc space height, thickness of ligamentum flavum, spinal dural sac transverse area, disc degeneration, facet hypertrophy, and disc contour.
Results: In all patients, both the upper segment (p=0.003) and lower segment (p=0.024) showed statistically significant differences between the two types of spondylolisthesis. Additionally, at the L4-L5 level (between the fourth and fifth lumbar vertebrae), there was a significant difference for the upper segment (p=0.005). There were statistically significant differences between the two types in the spinal dural sac transverse area in all patients for the upper segment (p=0.004), disc degeneration in all patients for the upper segment (p=0.003), disc contour in all patients for the upper segment (p=0.014), and L4-L5 level spondylolisthesis for the upper segment (p=0.021).
Conclusion: Disc space height measurements, spinal dual sac transverse area, disc degeneration, and disc contour were all worse in adjacent segments of degenerative spondylolisthesis compared with isthmic spondylolisthesis.
|8.||Ultrasound-guided Botulinum Toxin Injection into the Salivary Glands for Treating Sialorrhea in a Case of Small-cell Lung Cancer|
Murat Çabalar, Ayça Altınkaya, İlhan Nahit Mutlu
doi: 10.4274/csmedj.galenos.2022.2021-12-2 Pages 78 - 80
Sialorrhea or excessive drooling is an important problem known as saliva spillage from the mouth. Drooling may accompany many diseases, especially chronic neurological diseases and other chronic diseases. A 57-year-old female patient presented with a complaint of drooling that started after concurrent chemotherapy and radiotherapy due to small-cell lung cancer. The patients complaints were significantly reduced with an ultrasound-guided botulinum toxin injection into the salivary glands.
|9.||Moyamoya Case with Stenting for Basilar Stenosis|
Kamer Tandoğan, Ayça Özkul, Murat Çabalar, Özgür Kılıçkesmez, Uğur Demir, Tevfik Güzelbey, Mehmet Cingöz
doi: 10.4274/csmedj.galenos.2023.2022-2-2 Pages 81 - 85
Moyamoya disease is a chronic, progressive hereditary disease characterized by narrowing of the vascular lumen because of hypertrophy of smooth muscles in the walls of the arteries that form the circle of Willis. Cerebral vessels may be encountered in bleeding and occlusion clinics. Although it is seen as predominant in Asian races, cases have been reported worldwide. Although its etiopathogenesis is not clear, genetics, some infectious agents, and autoimmune mechanisms are blamed. The gold standard in diagnosis is digital subtraction angiography. Surgical or endovascular interventions can be used in patients with recurrent progressive ischemic events and decreased cerebral perfusion. Here we present a 43-yearold Moyamoya patient who presented with posterior system findings and had a stent implantation with critical stenosis in the basilar artery.