BACKGROUND Pancreatic cystic neoplasms(PCNs)are increasingly detected due to advancements in radiographic techniques,with a prevalence of approximately 15%in the general population.These lesions range from benign to p...BACKGROUND Pancreatic cystic neoplasms(PCNs)are increasingly detected due to advancements in radiographic techniques,with a prevalence of approximately 15%in the general population.These lesions range from benign to premalignant and malignant,posing a diagnostic challenge.Accurate differentiation is critical,as premalignant and malignant PCNs often require surgical intervention,while benign cysts may only need monitoring unless symptomatic.Current diagnostic methods,including cross-sectional imaging,endoscopic ultrasonography,and endoscopic ultrasonography-guided fine-needle aspiration/biopsy,are specialized,not universally available,and have variable accuracy.Clinical and laboratory parameters such as carbohydrate antigen 19-9(CA 19-9),neutrophillymphocyte ratio,platelet-lymphocyte ratio,and red cell distribution width(RDW)have been associated with malignancy risk,though only CA 19-9 is guideline-supported.AIM To assess the malignancy risk of PCNs using preoperative clinical and routine laboratory parameters.METHODS A retrospective cohort study analyzed 70 patients who underwent surgery for PCNs at Ankara Bilkent City Hospital between February 2019 and March 2023.Patients were categorized into group A(benign or low-grade dysplasia,n=40)and group B(malignancy or high-grade dysplasia,n=30)based on postoperative pathology.Preoperative demographic and laboratory parameters,including age,RDW,albumin,and CA 19-9,were compared.Univariate and multivariate logistic regression analyses identified independent predictors of malignancy.Receiver operating characteristic curve analysis evaluated predictive performance,with internal validation using bootstrapping.RESULTS Group B patients were older(69.86±9.58 years vs 52.74±16.85 years,P<0.001)and had a higher incidence of diabetes mellitus(57.1%vs 21.4%,P=0.002).RDW(16.2%vs 13.7%,P<0.001),platelet-lymphocyte ratio(178 vs 126,P=0.008),and CA 19-9(21.7 U/mL vs 9.3 U/mL,P=0.009)were significantly higher in group B,while albumin was lower(41 g/L vs 45 g/L,P=0.008).Multivariate analysis identified age[odds ratio=1.067,95%confidence interval(CI):1.014-1.122,P=0.012]and RDW(odds ratio=1.784,95%CI:1.172-2.715,P=0.007)as independent predictors.The area under the curve for age,RDW,and their combination was 0.798(95%CI:0.695-0.900),0.801(95%CI:0.692-0.911),and 0.858(95%CI:0.771-0.944),respectively,with bootstrapped validation confirming stability.Cut-off values of age≥60 years and RDW≥15.5%balanced sensitivity and specificity,increasing malignancy risk 15.3-fold and 22.6-fold,respectively.CONCLUSION Age and RDW are independent predictors of malignancy in PCNs,aiding in patient selection for advanced diagnostics and surgery.Larger,multicenter studies are needed to validate these findings.展开更多
Objective:To investigate the clinical symptoms of coronavirus disease 2019(COVID-19)patients with and without B.1.1.7 mutation.Methods:This retrospective observational study included COVID-19 patients who were divided...Objective:To investigate the clinical symptoms of coronavirus disease 2019(COVID-19)patients with and without B.1.1.7 mutation.Methods:This retrospective observational study included COVID-19 patients who were divided into two groups,the mutation and the non-mutation group.Demographics characteristics,clinical characteristics,laboratory parameters,and mortality rates were recorded and compared between the two groups.Results:A total of 196 patients were included in the study.The relationship between the mutant virus status and sex,age,comorbidity,survival status,and disease severity was not significant(P>0.05).No significant differences were found in duration of hospitalization between the mutation and the non-mutation group(P>0.05).However,there was a statistically significant difference between patients with and without mutant viruses in hemoglobin,mean platelet volume,procalcitonin,low density lipoprotein,iron-binding capacity,potassium,calcium,C-reactive protein,folate,creatine kinase myocardial band,D-dimer,and international normalized ratio(P<0.05).Conclusions:No significant difference is found in mortality rate,disease severity or duration of hospitalization between the patients with and without variant B.1.1.7.Careful monitoring of COVID-19 patients is required for all variants.展开更多
BACKGROUND The coronavirus disease 2019(COVID-19)pandemic has become a major health concern worldwide.In that context,the understanding of epidemiological and clinical features associated with the disease and its seve...BACKGROUND The coronavirus disease 2019(COVID-19)pandemic has become a major health concern worldwide.In that context,the understanding of epidemiological and clinical features associated with the disease and its severity is crucial for the establishment of strategies aimed at disease control and remedy.AIM To describe epidemiological features,signs,symptoms,and laboratory findings among severely ill COVID-19 patients from an inten-sive care unit in northeastern Brazil as well as to evaluate predictor factors for disease outcomes.METHODS This is a prospective single-center study that evaluated 115 patients admitted to the intensive care unit in a northeastern Brazilian hospital.RESULTS The patients had a median age of 65.60±15.78 years.Dyspnea was the most frequent symptom,affecting 73.9%of the patients,followed by cough(54.7%).Fever was reported in approximately one-third of patients and myalgia in 20.8%of the patients.At least two comorbidities were found in 41.7%of the patients,and hypertension was the most prevalent(57.3%).In addition,having two or more comorbidities was a predictor of mortality,and lower platelet count was positively associated with death.Nausea and vomiting were two symptoms that were predictors of death,and the presence of a cough was a protective factor.CONCLUSION This is the first report of a negative correlation between cough and death in severely ill severe acute respiratory syndrome coronavirus 2-infected individuals.The associations between comorbidities,advanced age,and low platelet count and the outcomes of the infection were similar to the results of previous studies,highlighting the relevance of these features.展开更多
Patients with non-ST-elevation acute coronary syndrome(NSTE-ACS)have diverse clinical trajectories and form a heterogeneous group[1].They exhibit differences in clinical and angiographic findings,laboratory parameters...Patients with non-ST-elevation acute coronary syndrome(NSTE-ACS)have diverse clinical trajectories and form a heterogeneous group[1].They exhibit differences in clinical and angiographic findings,laboratory parameters including platelet function,and the severity of concomitant pathology.These variations affect their clinical courses and prognosis[1,2].展开更多
Objective:To explore the underlying causes of death among vaccinated COVID-19 patients.Methods:The medical record of COVID-19 patients admitted to the main COVID-19 referral center in southeast Iran from January to Ma...Objective:To explore the underlying causes of death among vaccinated COVID-19 patients.Methods:The medical record of COVID-19 patients admitted to the main COVID-19 referral center in southeast Iran from January to March 2022 was investigated.Then,risk factors for mortality were statistically assessed.Results:92 patients were included,with 50 in infectious disease ward and 42 in ICU ward.In total,37%of patients succumbed to COVID-19.The median age of those who died was 69.9 years.Dementia and genitourinary system-related diseases was associated with an increased risk of death[6.00(95%CI:1.14-31.66)and 4.93(95%CI:1.80-13.52)].Furthermore,the elevated levels of white blood cells,neutrophils,lactate dehydrogenase,blood urea nitrogen,and creatinine were associated with an increased risk of death by 4.93(95%CI:1.82-13.36),16.57(95%CI:2.10-131.31),3.23(95%CI:1.15-9.03),4.48(95%CI:1.78-11.31),and 4.27(95%CI:1.49-12.22),respectively.Conclusions:Despite receiving the SARS-CoV-2 vaccine,individuals who suffer from dementia and genitourinary system-related diseases are at risk of death with new strains of SARS-CoV-2 infection.Furthermore,the increase of white blood cell,neutrophils,lactate dehydrogenase,blood urea nitrogen,and creatinine in patients’blood can be considered as warning indicators of disease progression and death.展开更多
This study,which included patients over the age of 18 who were diagnosed with coronavirus disease 2019(COVID-19)in the emergency clinic,aims to determine the relationship between coagulation parameters and mortality.E...This study,which included patients over the age of 18 who were diagnosed with coronavirus disease 2019(COVID-19)in the emergency clinic,aims to determine the relationship between coagulation parameters and mortality.Epidemiologic data such as age,gender,medical history,vital parameters at emergency department admission,clinical findings,coagulation parameters such as d-dimer,prothrombin time(PT),active partial thromboplastin time(aPTT),international normalized ration(INR),fibrinogen,and platelet were evaluated.Patients with positive computerized tomography(CT)findings and positive polymerase chain reaction(PCR)together were included in the study.It was revealed that d-dimer,fibrinogen,INR,and PT values were higher in the elderly group.It was shown that there was a significant relationship between hospitalization days(ward or intensive care unit)and d-dimer levels.It was observed that d-dimer,fibrinogen elevation was significantly associated with prognosis by increasing mortality,and that platelet and aPTT values were also associated with prognosis and were lower in the mortality group.On the other hand,in receiver operating characteristic(ROC)analysis,the sensitivity and specificity data were 80.3%/80.0%for d-dimer,70.5%/72.2%for fibrinogen,58.2%/59.4%for aPTT,and 59.7%/59.2%for platelet,respectively.The overall classification success was 88.6%and mortality prediction success was 37.7%in the regression model of some coagulation parameters(d-dimer,fibrinogen,aPTT,and platelet)which were effective on prognosis.In conclusion,it was determined that d-dimer,fibrinogen,aPTT,and platelet parameters were directly associated with mortality and when these coagulation parameters were used together with the clinical,vital,and demographic data of the patients,the success of mortality prediction increased significantly.展开更多
文摘BACKGROUND Pancreatic cystic neoplasms(PCNs)are increasingly detected due to advancements in radiographic techniques,with a prevalence of approximately 15%in the general population.These lesions range from benign to premalignant and malignant,posing a diagnostic challenge.Accurate differentiation is critical,as premalignant and malignant PCNs often require surgical intervention,while benign cysts may only need monitoring unless symptomatic.Current diagnostic methods,including cross-sectional imaging,endoscopic ultrasonography,and endoscopic ultrasonography-guided fine-needle aspiration/biopsy,are specialized,not universally available,and have variable accuracy.Clinical and laboratory parameters such as carbohydrate antigen 19-9(CA 19-9),neutrophillymphocyte ratio,platelet-lymphocyte ratio,and red cell distribution width(RDW)have been associated with malignancy risk,though only CA 19-9 is guideline-supported.AIM To assess the malignancy risk of PCNs using preoperative clinical and routine laboratory parameters.METHODS A retrospective cohort study analyzed 70 patients who underwent surgery for PCNs at Ankara Bilkent City Hospital between February 2019 and March 2023.Patients were categorized into group A(benign or low-grade dysplasia,n=40)and group B(malignancy or high-grade dysplasia,n=30)based on postoperative pathology.Preoperative demographic and laboratory parameters,including age,RDW,albumin,and CA 19-9,were compared.Univariate and multivariate logistic regression analyses identified independent predictors of malignancy.Receiver operating characteristic curve analysis evaluated predictive performance,with internal validation using bootstrapping.RESULTS Group B patients were older(69.86±9.58 years vs 52.74±16.85 years,P<0.001)and had a higher incidence of diabetes mellitus(57.1%vs 21.4%,P=0.002).RDW(16.2%vs 13.7%,P<0.001),platelet-lymphocyte ratio(178 vs 126,P=0.008),and CA 19-9(21.7 U/mL vs 9.3 U/mL,P=0.009)were significantly higher in group B,while albumin was lower(41 g/L vs 45 g/L,P=0.008).Multivariate analysis identified age[odds ratio=1.067,95%confidence interval(CI):1.014-1.122,P=0.012]and RDW(odds ratio=1.784,95%CI:1.172-2.715,P=0.007)as independent predictors.The area under the curve for age,RDW,and their combination was 0.798(95%CI:0.695-0.900),0.801(95%CI:0.692-0.911),and 0.858(95%CI:0.771-0.944),respectively,with bootstrapped validation confirming stability.Cut-off values of age≥60 years and RDW≥15.5%balanced sensitivity and specificity,increasing malignancy risk 15.3-fold and 22.6-fold,respectively.CONCLUSION Age and RDW are independent predictors of malignancy in PCNs,aiding in patient selection for advanced diagnostics and surgery.Larger,multicenter studies are needed to validate these findings.
文摘Objective:To investigate the clinical symptoms of coronavirus disease 2019(COVID-19)patients with and without B.1.1.7 mutation.Methods:This retrospective observational study included COVID-19 patients who were divided into two groups,the mutation and the non-mutation group.Demographics characteristics,clinical characteristics,laboratory parameters,and mortality rates were recorded and compared between the two groups.Results:A total of 196 patients were included in the study.The relationship between the mutant virus status and sex,age,comorbidity,survival status,and disease severity was not significant(P>0.05).No significant differences were found in duration of hospitalization between the mutation and the non-mutation group(P>0.05).However,there was a statistically significant difference between patients with and without mutant viruses in hemoglobin,mean platelet volume,procalcitonin,low density lipoprotein,iron-binding capacity,potassium,calcium,C-reactive protein,folate,creatine kinase myocardial band,D-dimer,and international normalized ratio(P<0.05).Conclusions:No significant difference is found in mortality rate,disease severity or duration of hospitalization between the patients with and without variant B.1.1.7.Careful monitoring of COVID-19 patients is required for all variants.
基金Supported by FAPEMIG Edital 001/2020-Programa Emergencial de Apoio a Ações de Enfrentamento da Pandemia Causada pelo Novo Coronavírus.FUNDAÇÃO DE AMPAROÀPESQUISA DO ESTADO DA BAHIA–FAPESB,PPSUS-Programa Pesquisa para o SUS-Headline 02/2020,Term of Grant nºSUS0025/2021Magalhães Queiroz DM,Freire de Melo F,are research fellows of the Conselho Nacional de Desenvolvimento Científico e Tecnológico(CNPq-)–Brazil.Programa Permanecer da Universidade Federal da Bahia.Programa Institucional de Bolsas de Iniciação Científica da Universidade Federal da Bahia(PIBIC-UFBA).
文摘BACKGROUND The coronavirus disease 2019(COVID-19)pandemic has become a major health concern worldwide.In that context,the understanding of epidemiological and clinical features associated with the disease and its severity is crucial for the establishment of strategies aimed at disease control and remedy.AIM To describe epidemiological features,signs,symptoms,and laboratory findings among severely ill COVID-19 patients from an inten-sive care unit in northeastern Brazil as well as to evaluate predictor factors for disease outcomes.METHODS This is a prospective single-center study that evaluated 115 patients admitted to the intensive care unit in a northeastern Brazilian hospital.RESULTS The patients had a median age of 65.60±15.78 years.Dyspnea was the most frequent symptom,affecting 73.9%of the patients,followed by cough(54.7%).Fever was reported in approximately one-third of patients and myalgia in 20.8%of the patients.At least two comorbidities were found in 41.7%of the patients,and hypertension was the most prevalent(57.3%).In addition,having two or more comorbidities was a predictor of mortality,and lower platelet count was positively associated with death.Nausea and vomiting were two symptoms that were predictors of death,and the presence of a cough was a protective factor.CONCLUSION This is the first report of a negative correlation between cough and death in severely ill severe acute respiratory syndrome coronavirus 2-infected individuals.The associations between comorbidities,advanced age,and low platelet count and the outcomes of the infection were similar to the results of previous studies,highlighting the relevance of these features.
文摘Patients with non-ST-elevation acute coronary syndrome(NSTE-ACS)have diverse clinical trajectories and form a heterogeneous group[1].They exhibit differences in clinical and angiographic findings,laboratory parameters including platelet function,and the severity of concomitant pathology.These variations affect their clinical courses and prognosis[1,2].
文摘Objective:To explore the underlying causes of death among vaccinated COVID-19 patients.Methods:The medical record of COVID-19 patients admitted to the main COVID-19 referral center in southeast Iran from January to March 2022 was investigated.Then,risk factors for mortality were statistically assessed.Results:92 patients were included,with 50 in infectious disease ward and 42 in ICU ward.In total,37%of patients succumbed to COVID-19.The median age of those who died was 69.9 years.Dementia and genitourinary system-related diseases was associated with an increased risk of death[6.00(95%CI:1.14-31.66)and 4.93(95%CI:1.80-13.52)].Furthermore,the elevated levels of white blood cells,neutrophils,lactate dehydrogenase,blood urea nitrogen,and creatinine were associated with an increased risk of death by 4.93(95%CI:1.82-13.36),16.57(95%CI:2.10-131.31),3.23(95%CI:1.15-9.03),4.48(95%CI:1.78-11.31),and 4.27(95%CI:1.49-12.22),respectively.Conclusions:Despite receiving the SARS-CoV-2 vaccine,individuals who suffer from dementia and genitourinary system-related diseases are at risk of death with new strains of SARS-CoV-2 infection.Furthermore,the increase of white blood cell,neutrophils,lactate dehydrogenase,blood urea nitrogen,and creatinine in patients’blood can be considered as warning indicators of disease progression and death.
文摘This study,which included patients over the age of 18 who were diagnosed with coronavirus disease 2019(COVID-19)in the emergency clinic,aims to determine the relationship between coagulation parameters and mortality.Epidemiologic data such as age,gender,medical history,vital parameters at emergency department admission,clinical findings,coagulation parameters such as d-dimer,prothrombin time(PT),active partial thromboplastin time(aPTT),international normalized ration(INR),fibrinogen,and platelet were evaluated.Patients with positive computerized tomography(CT)findings and positive polymerase chain reaction(PCR)together were included in the study.It was revealed that d-dimer,fibrinogen,INR,and PT values were higher in the elderly group.It was shown that there was a significant relationship between hospitalization days(ward or intensive care unit)and d-dimer levels.It was observed that d-dimer,fibrinogen elevation was significantly associated with prognosis by increasing mortality,and that platelet and aPTT values were also associated with prognosis and were lower in the mortality group.On the other hand,in receiver operating characteristic(ROC)analysis,the sensitivity and specificity data were 80.3%/80.0%for d-dimer,70.5%/72.2%for fibrinogen,58.2%/59.4%for aPTT,and 59.7%/59.2%for platelet,respectively.The overall classification success was 88.6%and mortality prediction success was 37.7%in the regression model of some coagulation parameters(d-dimer,fibrinogen,aPTT,and platelet)which were effective on prognosis.In conclusion,it was determined that d-dimer,fibrinogen,aPTT,and platelet parameters were directly associated with mortality and when these coagulation parameters were used together with the clinical,vital,and demographic data of the patients,the success of mortality prediction increased significantly.
