Revista da Associação Médica Brasileira, Volume: 67, Issue: 10, Published: 2021
  • Blurred lines for management of thyroid nodules in the era of atypia of undetermined significance/ follicular lesion of undetermined significance: novel subdivisions of categories IIIA and IIIB in a possible forthcoming The Bethesda System for Reporting Thyroid Cytopathology, 3rd edition; amending versus unnecessary? Point Of View

    Sengul, Ilker; Sengul, Demet
  • “New Homeopathic Medicines” proposal: a database made available in three free-access bilingual digital books Short Communication

    Teixeira, Marcus Zulian
  • COVID-19 pandemic and exercising: a cross-sectional study with 1156 patients with fibromyalgia Original Article

    Martins, Isabela Paula Mundim; Bodenmuller, Pedro Henrique Kopp; Mello, Daniel Bozza de Oliveira; Skare, Thelma Larocca

    Abstract in English:

    SUMMARY OBJECTIVE: The aim of this study was to analyze the effects of pandemic in the exercising practice and impact of the disease in patients with Fibromyalgia. METHODS: This is a cross-sectional, Internet-based survey answered by 1156 individuals with Fibromyalgia diagnosis. Questions were on epidemiology, social distancing habits, and exercise practice before and after COVID-19 pandemic, including subtypes of exercises (for resistance, flexibility, balance, and strength). The Fibromyalgia Impact Questionnaire was applied. RESULTS: In the whole sample, 57.7% of individuals practiced exercises before pandemic; during pandemic, only 34.8% practiced and 39.6% left this practice. Among those taking quarantine (n=440), 52.9% used to do exercises prior to pandemic; in the pandemic, 28.1% (reduction of 53.2%). The median Fibromyalgia Impact Questionnaire among those who practiced exercises in the pandemic was 73.6 (61.1–83.2) and that among those who did not was 80.4 (71.9–86.9), with p<0.0001. The Fibromyalgia Impact Questionnaire did not change according to the type of physical exercise (p=0.27). CONCLUSION: A high proportion of patients with Fibromyalgia stopped exercising during COVID-19 pandemic; as a result, the impact of the disease during this period was worse among those not practicing exercises.
  • Hesitation regarding the COVID-19 vaccine among medical students in Brazil Original Article

    Chaves, Ítalo Emanoel de Sousa; Brito, Paulo Roberto Pinheiro; Rodrigues, João Guilherme Bentes de Araújo; Costa, Milena Silva; Cândido, Estelita Lima; Moreira, Maria Rosilene Cândido

    Abstract in English:

    SUMMARY OBJECTIVE: This study aims to know the main determinants of hesitation to the vaccine against COVID-19 mentioned by medical students in Brazil. METHODS: A cross-sectional study with 250 students who answered the online questionnaire between December 18, 2020 and January 8, 2021. RESULTS: Most students (84%) mentioned the intention to take anti-COVID vaccine and 14% were hesitant. Information provided by governments (59.2%), the pharmaceutical industry (54.4%), and the press (51.6%) were the items that most generated vaccine hesitation. CONCLUSION: In the context of the COVID-19, vaccine hesitation is an additional concern because adherence to vaccination is a recurring challenge. The category of contextual influences predominated among the main determinants of anti-COVID vaccine hesitation expressed by medical students in Brazil, disfavoring vaccine adherence in this public.
  • Immunogenicity after CoronaVac vaccination Original Article

    Güzel, Eda Çelik; Çelikkol, Aliye; Erdal, Berna; Sedef, Nuriye

    Abstract in English:

    SUMMARY OBJECTIVE: This study aimed to investigate the seropositivity of CoronaVac-SinoVac vaccination in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) risk factors and comorbidities. METHODS: Immunoglobulin (IgG) antibody responses were examined on the 21st day after the second dose of CoronaVac-SinoVac 6 μg vaccine on the 28th day. SARS-CoV-2 IgG antibody levels were measured by using the enzyme-linked immunosorbent assay method in vaccinated health care workers (n=134) (Group I), vaccinated polymerase chain reaction (PCR) (+) who had coronavirus-19 (COVID-19) disease (n=21) (Group II), and unvaccinated PCR (+) (n=28) (Group III) participants. Subgroups were formed in Group I according to the presence of COVID-19 risk factors and comorbidities (diabetes mellitus, cardiovascular disease, and asthma/allergy) and demographic data. RESULTS: Seropositivity rates were 95.5, 100, and 89.3% for Groups I, II, and III, respectively. IgG antibody levels were found significantly higher in the group between the ages of 20–30 in group I compared to those aged 31–50 and over 50 (both p<0.01). It was found significantly higher in normal-weight individuals than in the overweight and obese group (both p<0.01). IgG antibody levels were found significantly lower in people with cardiovascular disease and diabetes mellitus compared with those who did not (p<0.05 and p<0.001, respectively). There was a negative correlation between IgG antibody response values and body mass index and age in Group I (r= −0.336, p<0.001 and r= −0.307, p<0.001, respectively). CONCLUSION: IgG antibody values decrease with age and with increasing body mass index. The presence of comorbidities (i.e., diabetes mellitus and cardiovascular disease) decreased COVID-19 IgG antibody values.
  • COVID-19 findings in chest computed tomography Original Article

    Calvi, Camila; Ferreira, Fernanda Filetti; Lyrio, Lucas; Baptista, Rodrigo de Melo; Zanoni, Barbara Binda; Junger, Ynara Olivier; Barros, Wagner Haese; Volpato, Ricardo; Mule Júnior, Libório; Rosa Júnior, Marcos

    Abstract in English:

    SUMMARY OBJECTIVE: The aim of this study was to describe chest computed tomography image findings in patients with COVID-19. METHODS: The chest computed tomography scans of 453 hospitalized patients with confirmed COVID-19 were collected at two tertiary care Brazilian hospitals. Demographics and clinical data were extracted from the electronic record medical system. RESULTS: The main chest computed tomography findings were ground-glass opacities (92.5%), consolidation (79.2%), crazy-paving pattern (23.9%), parenchymal bands (50%), septal thickening (43.5%), and inverted halo sign (3.5%). Of the 453 hospitalized patients, 136 (30%) died. In this group, ground-glass opacities (94.1%), consolidation (89.7%), septal thickening (58.1%), crazy-paving pattern (52.2%), and parenchymal bands (39.7%) were the most common imaging findings. CONCLUSIONS: In a dynamic disease with a broad clinical spectrum such as COVID-19, radiologists can cooperate in a better patient management. On wisely indicated chest computed tomography scans, the fast identification of poor prognosis findings could advise patient management through hospital care facilities and clinical team decisions.
  • Decreased ovarian reserve and ovarian morphological alterations in female rat offspring exposed to a ketogenic maternal diet Original Article

    Budak, Özcan; Bostancı, Mehmet Sühha; Kurtoğlu, Erdal; Toprak, Veysel

    Abstract in English:

    SUMMARY OBJECTIVE: This study evaluates the effects of a ketogenic diet on morphology and follicle reserve. METHOD: Sixteen Sprague-Dawley rats were randomized into two groups: standard diet group (n=8) and ketogenic diet group (n=8). Rats were time mated. Dams were permitted to deliver spontaneously. The animals were monitored for the onset of puberty. All the rats were weighed and anesthetized, serum anti-Müllerian hormone level was measured, and the oviducts were removed. The morphological characteristics of follicles were determined and total ovarian volumes were calculated. RESULTS: The mean ovarian volume was statistically significantly lower in the ketogenic diet group compared to the standard diet group (14.41±0.99 mm3 versus 18.89±1.28 mm3) (p=0.000). The mean number of antral follicles was 13.63±1.80 in the standard diet group and 4.462±0.760 in the ketogenic diet group. The mean ovarian weight of the ketogenic diet group was significantly lower than that of the standard diet group (0.42±0.06 g versus 0.815±107 g). The mean anti-Müllerian hormone levels were significantly higher in the standard diet group compared to the ketogenic diet group (1.023±4.75 ng/mL versus 0.69±0.07 ng/mL) (p=0.000). The mean percentage of staining of Ki-67 was 35.28±4.75 in the standard diet group and 16.98±3.33 in the ketogenic diet group (p=0.000). CONCLUSION: Maternal ketogenic diet reduces ovarian follicular reserve in female offspring and has important implications for maintaining reproductive potential at a population level.
  • Can blood urea Nitrogen-to-Albumin ratio predict mortality in patients with moderate-to-severe COVID-19 pneumonia hospitalized in the intensive care unit? Original Article

    Ata, Filiz; As, Ahmet Kagan; Engin, Mesut; Kat, Nurcan Kacmaz; Ata, Yusuf; Turk, Tamer

    Abstract in English:

    SUMMARY OBJECTIVE: Many laboratory parameters allow to follow up the course of the disease and reveal its clinical severity, particularly in patients with coronavirus disease 2019 (COVID-19) pneumonia. In this study, we aimed to investigate the role of the blood urea nitrogen-to-albumin ratio in predicting the mortality in COVID-19 patients with moderate-to-severe disease who are hospitalized in the intensive care unit. METHODS: A total of 358 patients who were hospitalized in intensive care unit at our hospital between November 1, 2020 and May 15, 2021 were included in this study. During their course of intensive care, surviving patients were included in Group 1 and nonsurviving patients in Group 2. RESULTS: There were no statistically significant differences between the two groups in terms of gender, smoking, and chronic obstructive pulmonary disease rates. In multivariate logistic regression analysis, advanced age (OR 1.038, 95%CI 1.014–1.064, p=0.002), neutrophil-to-lymphocyte ratio (OR 1.226, 95%CI 1.020–1.475, p=0.030), blood urea nitrogen-to-albumin ratio (OR 2.693, 95%CI 2.019–3.593, p<0.001), and chest computed tomography severity score (OR 1.163, 95%CI 1.105–1.225, p<0.001) values were determined as independent predictors for in-hospital mortality. CONCLUSION: In this study, we showed that the blood urea nitrogen-to-albumin ratio, which was previously shown as a predictor of mortality in patients with various pneumonia, was an independent predictor of mortality in patients with COVID-19 pneumonia.
  • Effectiveness of telemedicine in response to the COVID-19 pandemic Original Article

    Souza, Maria Angela de; Fioretti, Audrey Cristina; Vincentin, Aparecida Helena; Botelho, Ricardo Vieira; Vasconcellos, Cidia

    Abstract in English:

    SUMMARY OBJECTIVE: The aim of this study was to evaluate the utility of the telemedicine care model implemented to treat and guide patients with COVID-19 related symptoms and indicators during the pandemic. METHODS: This is a retrospective study with data collected from the electronic records of standardized forms for assistance. As a way of evaluating the work performed, the number of consultations, types of referrals, efficiency of care, and patient satisfaction were observed. RESULTS: Between April 2 and October 15, 2020, 92 professionals attended 3,660 patients by telemedicine; out of them, 523 (14.3%) were referred to a COVID-19 attending room, 128 (3.5%) to other specialties, 123 (3.4%) to a general emergency department, and 2,886 (78.9%) were monitored via home care. Of the total number of patients, 81 (2.2%) were hospitalized, and 13 (0.35%) died. CONCLUSION: Telemedicine offered useful tools for the care, treatment, and monitoring of patients with COVID-19 during the pandemic. The service was considered by most respondents as satisfactory, resolutive, or safe.
  • Lung age and respiratory muscle strength in female volleyball players Original Article

    Çelik, Zeliha; Güzel, Nevin Atalay; Yüksel, Fuat; Kafa, Nihan

    Abstract in English:

    SUMMARY OBJECTIVE: Lung age estimation is a useful approach to determine pulmonary pathologies. In literature, no studies have evaluated and compared lung age in athletes with healthy volunteers. This study aims to compare lung age and respiratory muscle strength in female volleyball players and age-matched healthy volunteers. METHODS: A total of 18 female volleyball players (22.39±4.97 years) and 20 female healthy volunteers (24.85±3.33 years) were included. Pulmonary functions and respiratory muscle strength were assessed using a spirometer and mouth pressure device, respectively. The lung age was calculated using reference equations associated with gender, height, and forced expiratory volume in 1 second. RESULTS: Lung age was significantly lower, and forced expiratory volume in 1 L, forced vital capacity, and maximal inspiratory and expiratory pressure (cmH2O, %) were higher in female volleyball players compared with healthy volunteers (p≤0.05). CONCLUSION: The lung age and respiratory muscle strength of female volleyball players were better than healthy volunteers. Regular training in female volleyball players may improve respiratory functions and lung age.
  • Can serum 8-hydroxy-2'-deoxyguanosine levels reflect the severity of pulmonary arterial hypertension? Original Article

    Coskun, Fatma Yılmaz; Taysı, Seyithan; Kayıkçıoğlu, Meral

    Abstract in English:

    SUMMARY OBJECTIVE: Oxidative stress plays a pivotal role in the pathogenesis of pulmonary arterial hypertension. 8-Hydroxy-2'-deoxyguanosine is a sensitive biomarker that reflects the degree of oxidative damage to DNA. We investigated whether serum 8-Hydroxy-2'-deoxyguanosine is a clinically useful biomarker for the severity of pulmonary arterial hypertension. METHODS: We measured serum 8-Hydroxy-2'-deoxyguanosine levels in 25 patients (age 37±13 years, 68% women) diagnosed with idiopathic pulmonary arterial hypertension, familial pulmonary arterial hypertension, or pulmonary arterial hypertension associated with congenital heart disease. The severity of pulmonary arterial hypertension was evaluated by six-min walking distance, World Health Organization functional class, and serum brain natriuretic peptide levels. Age and gender-matched 22 healthy subjects served as the control group. RESULTS: The comparison of 8-Hydroxy-2'-deoxyguanosine levels between patients and controls was not statistically different [(19.86±9.79) versus (18.80±3.94) ng/mL, p=0.622)]. However, there was a significant negative correlation between 8-Hydroxy-2'-deoxyguanosine levels and six-min walking distance (r= −0.614, p=0.001). Additionally, serum 8-Hydroxy-2'-deoxyguanosine levels in patients with functional class III–IV were significantly higher than those with functional class I–II (functional class III–IV 32.31±10.63 ng/mL versus functional class I–II 16.74±6.81 ng/mL, respectively, p=0.003). CONCLUSION: The 8-Hydroxy-2'-deoxyguanosine levels were significantly correlated with exercise capacity (six-min walking distance) and symptomatic status (functional class), both of which show the severity of pulmonary arterial hypertension in patients.
  • Role of mean platelet volume in differential diagnosis of adult-onset Still's disease and sepsis Original Article

    Luo, Liyan; Zhang, Litao; Jiang, Jiahong; Ding, Xiaoxia

    Abstract in English:

    SUMMARY OBJECTIVES: Mean platelet volume is a simple biomarker for inflammatory disease. The purpose of this study is to evaluate the role of mean platelet volume in distinguishing adult-onset Still's disease from sepsis. METHODS: We retrospectively selected 68 patients with adult-onset Still's disease and 55 patients with sepsis between January 2015 and December 2019. Related laboratory data were collected and analyzed. RESULTS: There were no significant differences in white blood cell counts, neutrophils, lymphocytes, and C-reactive protein between adult-onset Still's disease group and sepsis group. However, patients in adult-onset Still's disease group showed higher ferritin and platelets and lower mean platelet volume and platelet distribution width than those in sepsis group (p<0.01 for both). Receiver operating characteristic curve analysis was performed to distinguish adult-onset Still's disease and sepsis. The area under the curve of mean platelet volume was 0.761 (95%CI 0.673–0.849), with a sensitivity of 79.1%, a specificity of 63.3%, and a cutoff value of 10.9 fL. In contrast, the area under the curve of combined ferritin and mean platelet volume was 0.90l (95%CI 0.837–0.965), with higher sensitivity (82.8%) and specificity (96.2%). Therefore, mean platelet volume could be used as a supplementary indicator to distinguish adult-onset Still's disease from sepsis. CONCLUSION: We suggest that mean platelet volume could be used as a supplementary biomarker for differential diagnosis of adult-onset Still's disease and sepsis in addition to ferritin.
  • Evaluation of the effect of antibiotics used during parenteral nutrition treatment on Candidemia Original Article

    Yalçın, Nadir; Sürmelioğlu, Nursel; Özkan-Kuşcu, Özlem; Kelleci-Çakır, Burcu; Demirkan, Kutay; Gündüz, Murat

    Abstract in English:

    SUMMARY OBJECTIVE: Parenteral nutrition is an important risk factor for candidemia. In this risk analysis study, the effect of previous antibiotic administration apart from the length of hospital stay, duration of Parenteral nutrition treatment, and Candida score parameters on developing candidemia was evaluated in the non-neutropenic patients receiving Parenteral nutrition treatment. METHODS: In this double center, retrospective, and cross-sectional study, the data of patients who received Parenteral nutrition treatment were collected. Patients with or without candidemia after the initiation of Parenteral nutrition treatment were compared in terms of demographic features, Candida score, length of hospital stay, duration of Parenteral nutrition treatment, and previous use of antibiotics. Then, predictor factors affecting the probability of candidemia during Candida growth time were determined by the Cox regression analysis. RESULTS: A total of 148 patients (59.5% males) were included and 16 (10.81%) of these had candidemia after initiation of parenteral nutrition treatment. The median (min–max) duration of parenteral nutrition treatment was 11 (4–72) days and the Candida growth time was 13 (7–29) days. Statistically significant differences were found between patients with or without candidemia groups in terms of length of hospital stay (p<0.001), duration of parenteral nutrition treatment (p<0.001), and Candida score (p<0.001). To determine the effect of these variables and antibiotics on candidemia, length of hospital stay [Hazard Ratio 1.030; p=0.021] and piperacillin–tazobactam (Hazard Ratio 5.626; p=0.030) were found significant and independent risk factors on the development of candidemia. CONCLUSION: There are some well-known risk factors including length of hospital stay, duration of Parenteral nutrition treatment, and Candida score; the potential impact of piperacillin–tazobactam administration should also be considered since they may be effective on the development of candidemia.
  • Evaluation of the factors predicting the need for intensive care of patients with COVID-19 aged above 65 years: data from an emergency department in Turkey Original Article

    Akman, Canan; Das‚, Murat; Bardakçı, Okan; Akdur, Gökhan; Akdur, Okhan

    Abstract in English:

    SUMMARY OBJECTIVE: Individuals aged ≥65 years are more susceptible to COVID-19 disease and admission to intensive care is most notable. The scoring systems (national early warning score, quick sequential organ failure assessment, shock index) are recommended for rapid assessment of patients in emergency room conditions. The goal of our study is to evaluate scoring systems in conjunction with predictive factors of need for admission to intensive care of patients ≥65 years old with a diagnosis of COVID-19 who applied to the emergency room. METHODS: Patients were divided into two groups according to evolution in the emergency room, being those who needed or not intensive care. National Early Warning Score, quick sequential organ failure assessment, shock index scores and serum biochemistry, blood count and blood gas values were evaluated from hospital information management system records. RESULTS: Of the patients included in the study, 80.8% were admitted to the ward and 14.5% to the unit of intensive care. Lymphocyte count, base deficit and bicarbonate levels were lower, and the levels of C-reactive protein, lactate, D-dimer, urea and lactate dehydrogenase were higher in patients who needed intensive care. Quick sequential organ failure assessment and shock index were considered significant in the group admitted to the intensive care unit. CONCLUSIONS: We recommend that quick sequential organ failure assessment and shock index be used quickly, practically and easily in predicting the need for intensive care unit in patients aged ≥65 years in emergency department diagnosed with COVID-19.
  • Phobia of COVID-19 on people who aged 18 and older Original Article

    Zorlu, Mehmet; Kiskac, Nese; Kiskac, Muharrem

    Abstract in English:

    SUMMARY OBJECTIVES: Our aim was to evaluate the participants with the COVID-19 scale in order to see the effects of the COVID-19 pandemic on people, which has affected the whole world along with our country, to be able to take the necessary precautions for the current pandemic and similar pandemics and to minimize the negative aspects globally. METHODS: A total of 1010 people who aged 18 and older (between the ages of 18–76) were included in the research. Besides from the personal information of people who aged 18 and older such as a city of residence, age, gender, profession, education, the number of people who live in the same house, their chronic illnesses, marital status, and the existence of a child, a 20-question phobia of COVID-19 scale was carried out. The results were 95% reliable, and their significance was evaluated to be on p<0.05 level. RESULT: The COVID-19 Phobia Scale point for women was 54.97±14.44 while it was 51.28±14.06 for men, and between the two groups, there is a high level of significant difference (p<0.05) statistically, COVID-19 Phobia Scale point of people who have chronic illnesses is 56.51±15.84, meanwhile, the point of people who have no chronic illnesses was found to be 52.96±13.99, and it was detected that this difference was statistically significant (p<0.05). CONCLUSION: Besides the COVID-19 pandemic affecting the whole society, we see that the women population and people who have chronic illnesses are going through much more fear and anxiety.
  • Outcomes associated with Hydroxychloroquine and Ivermectin in hospitalized patients with COVID-19: a single-center experience Original Article

    Ferreira, Roberto Muniz; Beranger, Renata Wanderley; Sampaio, Pedro Paulo Noguères; Mansur Filho, João; Lima, Ricardo Antônio Correia

    Abstract in English:

    SUMMARY OBJECTIVE: Hydroxychloroquine and Ivermectin are advocated as potential treatments for coronavirus disease 2019 (COVID-19) despite the lack of supportive clinical evidence. In this study, outcomes associated with Hydroxychloroquine and/or Ivermectin were determined in a series of patients with confirmed COVID-19 from a single institution in Brazil. METHODS: Consecutive patients admitted between March and July 2020 were retrospectively analyzed and divided into four treatment categories: no treatment (Group 0), Ivermectin only (Group I), Hydroxychloroquine only (Group II), and Hydroxychloroquine and Ivermectin (Group III). Intensive care unit admission, mechanical ventilation, and death were compared between the Groups. RESULTS: A total of 230 patients were included, with the following treatment distribution: 35.2% (0), 9.1% (I), 48.3% (II), and 7.4% (III). Groups I, II, and III had the higher rates of Intensive care unit admission, mechanical ventilation, or death (0: 23.5% versus I: 38.1% versus II: 37.8% versus III: 70.6%, p=0.002), and the greatest mortality was found in Group III (0 versus III: 13.6% versus 35.3%, p=0.03). In the multivariate analysis, Hydroxychloroquine remained significantly associated with death (OR 3.3, 95%CI 1.1–9.6, p=0.03). CONCLUSION: In a series of consecutive hospitalized patients with COVID-19, Ivermectin was not associated with improved outcomes and Hydroxychloroquine may have resulted in a harmful effect.
  • COVID-19 in Turkish health care workers practicing chest medicine Original Article

    Sandal, Abdulsamet; Toreyin, Zehra Nur; Salturk, Cuneyt; Arbak, Peri Meram

    Abstract in English:

    SUMMARY OBJECTIVE: This study aimed to evaluate the data of Turkish health care workers practicing chest medicine on their coronavirus disease 2019 (COVID-19) status and related parameters. METHODS: This descriptive study included online survey data that the Turkish Thoracic Society conducted with its members in two phases starting in June and December 2020. The 33-item survey included demographic data, smoking status, the presence of any chronic diseases, occupation, working status, and non–work-related and work-related COVID-19 exposure characteristics. RESULTS: Of 742 responses, 299 (40.3%) reported that they had contracted COVID-19. The second survey detected a higher frequency of health care workers who had contracted COVID-19 (12.1% versus 57.4%, p<0.001) than the first survey. The analysis of the association between study parameters and COVID-19 in health care workers using logistic regression revealed statistical significance with working at the onset of the outbreak (OR 3.76, 95%CI 1.09–12.98, p=0.036), not working at the time of survey (OR 5.69, 95%CI 3.35–9.67, p<0.001), COVID-19 history in colleagues (OR 2.27, 95%CI 1.51–3.41, p<0.001), any non–work-related COVID-19 exposure (OR 4.72, 95%CI 2.74–8.14, p<0.001), COVID-19 exposure at home (OR 6.52, 95%CI 3.52–12.08, p<0.001), and COVID-19 history in family members (OR 8.16, 95%CI 5.52–12.08, p<0.001) after adjusting for age and sex. The study also observed an inverse relationship between the use of aprons and goggles and COVID-19 in health care workers. CONCLUSION: Occupational and nonoccupational characteristics are related to COVID-19 in health care workers practicing chest medicine. Therefore, active surveillance to detect health care workers contracting COVID-19 and to document and control occupational and nonoccupational risks should be provided.
  • Comparison of samples found positive by anti-HCV screening test with line immunoassay and determination of threshold value Original Article

    Atalay, Mustafa Altay; Sağıroğlu, Pinar; Oskay, Mehtap; Emir, Büşra

    Abstract in English:

    SUMMARY OBJECTIVE: This study aimed to compare the serum samples found reactive (≥1–≤20 signal-to-cutoff ratio) with Elecsys antibodies to hepatitis C virus screening test with innogenetics-line immunassay hepatitis C Virus Score test and to determine the most appropriate threshold value for our country, since positive results close to the cutoff value cause serious problems in routine diagnostic laboratories. METHODS: Antibodies to hepatitis C virus-positive samples from 687 different patients were included in the study. Antibodies to hepatitis C virus antibody detection was performed using Elecsys antibodies to hepatitis C virus II kits (Roche Diagnostics, Germany), an electrochemiluminescence method based on the double-antigen sandwich principle, on the Cobas e601 analyzer (Roche Diagnostics) in accordance with the recommendations of the manufacturer. Samples that were initially identified as reactive were studied again. Samples with ≥1–≤20 signal-to-cutoff ratio reagents as a result of retest were included in the study to be validated with the third-Generation Line immunassay kit (innogenetics-line immunassay hepatitis C Virus, Belgium). RESULTS: A total of 687 samples with antibodies to hepatitis C virus positive and levels between 1–20 S/Co were found to be 56.1% negative, 14.8% indeterminate, and 29.1% positive by innogenetics-line immunassay hepatitis C Virus confirmation test. When the cases with indeterminate innogenetics-line immunassay hepatitis C Virus test results were accepted as positive, the signal-to-cutoff ratio value for antibodies to hepatitis C virus was determined as 5.8 (95% confidence interval) in distinguishing the innogenetics-line immunassay hepatitis C Virus negative and positive groups. CONCLUSION: It was concluded that with further studies on this subject, each country should determine the most appropriate S/Co value for its population, and thus it would be beneficial to reduce the problems such as test repetition and cost increase.
  • Factors associated with postoperative complications following appendectomy in elderly patients Original Article

    Lapsekili, Emin; Deniz, Abdulkadir; Celik, Suleyman Utku

    Abstract in English:

    SUMMARY OBJECTIVE: Appendicitis in elderly patients is more challenging due to delayed presentation and higher comorbidities, which are associated with increased postoperative morbidity. The aim of this study was to evaluate factors that predict 30-day complications in elderly patients undergoing appendectomy. METHODS: The records of elderly patients who underwent appendectomy were reviewed. The primary outcome was 30-day postoperative complications. Independent variables examined included demographic data, comorbidities, preoperative laboratory values, pathological findings, and surgical features. Both univariate and multivariate regression analyses were performed to identify factors associated with postoperative complications. RESULTS: Evaluation was performed on 80 patients, comprising 63.8% females with a mean age of 71.3 years. Notably, 19 (23.8%) patients had one or more complications within 30 days after surgery. No significant difference was found between patients with and without complications in respect of age, gender, or laboratory features. The rates of American Society of Anesthesiologists scores 3–4 (p=0.006), hypertension (p=0.016), cardiovascular disease (p=0.049), and obesity (p=0.040) were significantly higher for patients with complications than for those without. On multivariate analysis, obesity (OR 9.41), chronic obstructive pulmonary disease (OR 9.72), and open appendectomy (OR 14.87) were independently associated with 30-day postoperative complications. CONCLUSIONS: Older patients undergoing appendectomy tend to have poorer outcomes than younger patients. Therefore, it is critical to identify factors that could reduce the possibility of adverse outcomes in this frail population. The results of this study suggest that obesity, chronic obstructive pulmonary disease, and an open approach are independent factors for complications in elderly patients undergoing appendectomy.
  • Evaluation of the olfactory bulb volume and morphology in patients with coronavirus disease 2019: can differences create predisposition to anosmia? Original Article

    Akkaya, Hüseyin; Kizilog˘lu, Alper; Dilek, Okan; Belibag˘li, Cenk; Kaya, Ömer; Yılmaz, Cengiz; Gülek, Bozkurt

    Abstract in English:

    SUMMARY OBJECTIVE: This study aimed to investigate whether the volume and morphology of the olfactory bulb are effective in the occurrence of anosmia in patients after COVID-19 infection. METHODS: The olfactory bulbus volume was calculated by examining the brain magnetic resonance imaging of cases with positive (+) COVID-19 polymerase chain reaction test with and without anosmia. Evaluated magnetic resonance imaging images were the scans of patients before they were infected with COVID-19. The olfactory bulbus and olfactory nerve morphology of these patients were examined. The brain magnetic resonance imaging of 59 patients with anosmia and 64 controls without anosmia was evaluated. The olfactory bulb volumes of both groups were calculated. The olfactory bulb morphology and olfactory nerve types were examined and compared between the two groups. RESULTS: The left and right olfactory bulb volumes were calculated for the anosmia group and control group as 47.8±15/49.3±14.3 and 50.5±9.9/50.9±9.6, respectively. There was no statistically significant difference between the two groups. When the olfactory bulb morphology was compared between the two groups, it was observed that types D and R were dominant in the anosmia group (p<0.05). Concerning olfactory nerve morphology, type N was significantly more common in the control group (p<0.05). CONCLUSIONS: According to our results, the olfactory bulb volume does not affect the development of anosmia after COVID-19. However, it is striking that the bulb morphology significantly differs between the patients with and without anosmia. It is clear that the evaluation of COVID-19-associated smell disorders requires studies with a larger number of patients and a clinicoradiological approach.
  • C-reactive protein and neutrophil–lymphocyte ratio as predictors of mortality in coronavirus disease 2019 Original Article

    Ergenç, Hasan; Ergenç, Zeynep; Dog˘an, Muharrem; Usanmaz, Mustafa; Gozdas, Hasan Tahsin

    Abstract in English:

    SUMMARY OBJECTIVE: This study investigates whether C-reactive protein, platelet–lymphocyte ratio, and neutrophil–lymphocyte ratio could be useful to predict mortality in COVID-19. METHODS: Data of 635 patients with COVID-19 followed up in Sinop Ataturk State Hospital from February to May 2020 were evaluated retrospectively. Diagnosis of COVID-19 was made according to the interim guidance of the World Health Organization. Patients were grouped into two groups based on mortality as survived and non-survived patients. Age, gender, neutrophil–lymphocyte ratio, platelet–lymphocyte ratio, and C-reactive protein of the groups were investigated and compared. RESULTS: The mean age of the participants was 55.8±22.3 years. Among the patients, 584 survived and 51 patients died. Age was significantly different between the groups, 54.2±22.3 in the survived group and 75.6±11.1 in the dead group (p=0.000). In addition, neutrophil, C-reactive protein, and neutrophil–lymphocyte ratio values were significantly higher in the dead group (p=0.000). platelet–lymphocyte ratio was slightly higher in the dead group, but this difference was not significant (p=0.42). The area under the curve values for age, lymphocyte, platelet, C-reactive protein, and neutrophil–lymphocyte ratio are 0.797, 0.424, 0.485, 0.778, and 0.729, respectively. CONCLUSIONS: Our results showed that neutrophil–lymphocyte ratio and C-reactive protein are significantly higher in patients leading to death and could be effective biomarkers in predicting COVID-19 fatality. Furthermore, C-reactive protein could be used as an independent biomarker to predict death in patients with COVID-19, regardless of gender and age (p=0.000).
  • Use of probiotics in pediatric patients with autism spectrum disorder: a systematic review Review Article

    Alvares, Matheus Alves; Serra, Mayco José Reinaldi; Delgado, Isabella; Carvalho, Joyce Canato de; Sotine, Thaís Campanhã Cury; Ali, Youssef Adef; Oliveira, Marcella Rocha Machado de; Rullo, Vera Esteves Vagnozzi
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