The Colistin-related nephrotoxicity and risk factors in the intensive care unit; a retrospective study (2021-01-11)
Objective: Colistimethate sodium (CMS) which is salvage therapy in the management of infections caused by multi-drug resistance (MDR) gram-negative pathogens is eliminated by the kidneys and cause nephrotoxicity. Many factors may also contribute to this nephrotoxic effect. In this study we aimed to determine the risks for the development of nephrotoxicity patients who received CMS in the intensive care unit (ICU).
Materials and Methods: We evaluated retrospectively of the patients who have lung cancer or COPD, aged older than 18 years, and received intravenous CMS therapy at least 72 hours in ICU. Patients’ age, comorbidities, C-reactive protein (CRP), procalcitonin, albumin, glomerular filtration rate (GFR), creatinine values on the 1st and 7th days of CMS treatment, positive inotropes, and nephrotoxic drugs used concurrently with CMS therapy, and renal replacement therapy (RRT) were recorded. RIFLE score , lenght of stay (LOS) in hospital and in the ICU, and 28-day mortality were also recorded.
Results: In this study, the GFR and creatinine level deteriorated significantly on the 7th day with CMS therapy patients who had preexisting lower GFR, hypoalbuminemia, and concomitant nephrotoxic drugs usage. The incidence of acute kidney injury was higher in malignant patients and 28-day mortality increased in patients with nephrotoxicity.
Conclusion: The CMS therapy with preexisting lower GFR, hypoalbuminemia, and concomitant nephrotoxic drugs usage significant risk factors to develop nephrotoxicity. It was also higher in malignant patients and increased 28-day mortality. Detailed clinical and laboratory evaluation of the patients is needed before CMS treatment.
Autism Spectrum Disorder Referrals to a Rural Hospital in the Past Two Years – A Retrospective Evaluation (2021-01-11)
Objective: In addition to the core symptoms of Autism Spectrum Disorder (ASD); symptoms such as aggression, self-harm, impulsivity, hyperactivity, anxiety, and mood problems are also often present. Medication use is frequent and studies report that 27-40% of ASD patients use at least one psychotropic medication. We aimed to examine the clinical and sociodemographic features and treatment modalities of ASD patients who were referred to a rural hospital in the last two years.
Material and Methods: Age, gender, mean diagnosis age (MDA), type of ASD, psychiatric symptoms, medication (if they use one) types, and doses were recorded for 200 children with ASD (who were referred between August 2018 – August 2020) were retrospectively evaluated. Also, patients who were diagnosed with “childhood autism (CA)” and “other ASD diagnoses” were compared.
Results: The majority of the patients were male, the MDA value of the all patients was 4.56 (±2.2) years and there were no significant differences between groups regarding MDA (p = 0.053). Most frequently seen psychiatric symptoms were behavioral (33%) and attention problems (21%) and 52.5% of patients (n=105) were using at least one psychotropic medication. Patients with CA had higher rates of psychotropic medication use (p=0.010) and the most frequently used medication group was antipsychotic drugs (92.4%).
Conclusion: Treatment approaches utilized in rural hospitals are in line with the universal trends. However, considerably higher MDA compared to previous studies show that; to provide early diagnosis and better prognosis for ASD patients who live in rural areas, new interventions should be promoted by the local and/or general authorities.
Effect of systemic immune-inflammation index on prognostic parameters and survival in patients with breast cancer under the age of 40 years (2021-01-16)
Objective: Systemic immune inflammation index, which is one of the systemic inflammatory markers obtained by using peripheral blood cells, neutrophils, lymphocyte and platelet counts, has been previously shown to be prognostic in many types of cancer, and it has been also shown in previous studies that SII was associated with prognosis in patients who received adjuvant and neoadjuvant therapy in breast cancer. In our study, the evaluation of the potential prognostic importance of SII in patients with breast cancer diagnosed before the age of 40 was aimed.
Material and method: For the study, demographic, histopathological, clinical and file data of 129 patients who were diagnosed with breast cancer in the tertiary medical oncology outpatient clinic and were 40 years old and younger at the time of diagnosis were recorded retrospectively. SII was calculated according to the neutrophil count x platelet number/lymphocyte (NxP / L) formula, and those below the optimal cut-off value obtained by ROC analysis were classified as low SII, and those above it as High SII. The relationship between breast cancer clinicopathological variables and SII was evaluated by Chi-Square test. While the effect of SII on survival was evaluated by Kaplan Meiermethod, the Logrank test was used to evaluate survival in low and high groups.
Results: For the study, 1400 patients diagnosed with breast cancer were reviewed and 129 patients who were under the age of 40 at the time of diagnosis were included. Patients who had insufficient follow-up or whose pre-treatment hemogram values could not be reached, who had medication use that could affect their hemogram parameters, and those with inflammatory diseases were not included. The median age in the study was 35, and the youngest patient was 21 years old. In the study group, based on the SII cut-off value of 720 calculated according to the roc analysis, 73 patients were in the low SII group and 56 patients were in the high SII group. When the relationship between prognostic factors of the patients and SII was examined, no statistically significant relationship was observed between age, hormone receptor status, Her-2 status, histological subtype, clinical stage, grade, Ki 67 status, lymph node involvement and SII. However, in the survival analysis, although the median value could not be reached between the two groups, there was a significant difference in overall survival with SII (p = 0.051) and it was observed that survival was worse in the high SII group, and the 3 and 5-year survival rates were worse in the high group compared to the low ones.
Conclusion: In our study, we reached the conclusion that SII can be an independent prognostic factor for survival in patients with breast cancer diagnosed at 40 years of age or younger. Considering the SII status together with other prognostic factors in diagnosis, a more intensive treatment plan can be made for the patients. However, well-designed prospective studies including more patients are needed for the routine use of SII.
The significance of Serum Vitamin D Levels on Changes in Hematological Parameters After Chemotherapy in Patients with Breast Cancer (2021-01-13)
Objective: To investigate the relationship between serum Vitamin D (VD) level and the change of hematological parameters after chemotherapy in patients with breast cancer (BC) who received adjuvant Adriamycin and Cyclophosphamide (AC).
Material and Methods: A total of 74 BC patients who were treated with adjuvant 60 mg/m2 Adriamycin and 600 mg/m2 Cyclophosphamide (AC) were included in the study. VD levels, complete blood count (CBC) findings after 1st cycle AC were retrospectively recorded. The relationship between changes in CBC parameters according to VD levels and the presence of hematological toxicity was examined.
Results: The mean age was 55.11±9.97 years and the median VD level was 12.78 (4-53.40) ng/mL. In all patient groups, there was a significant decrease in the values of lymphocytes and monocytes after chemotherapy (p=0.030, p=0.024 respectively). In the correlation analysis, there was no correlation between VD levels and hemoglobin levels, the number of cells in CBC-1, and the amount of change in the number of cells in after chemotherapy. However, there was a negative correlation between VD level and platelet/lymphocyte ratio-1 (PLR-1), monocyte/lymphocyte ratio-1 (MLR-1) (p=0.025, r:-0.237; p=0.001, r:-0.370, respectively), but there was no correlation with PLR-2 and MLR-2 (p>0.05 all).
Conclusion: There was no relationship between VD levels and changes in hematological parameters and hematological toxicity related to AC chemotherapy in the patient with BC. VD level was inversely correlated with PLR-1 and MLR-1, which is generally accepted as inflammatory markers. This result showed that the levels of VD do not have a significant role in the development of hematological toxicity after AC chemotherapy in BC.
Prognostic significance of ferritin, D-dimer, lymphocyte / monocyte ratio and some biochemical markers in patients with SARS-CoV-2 (2021-01-12)
Objective: The disease caused by Covid-19 that progress with severe acute respiratory distress syndrome (SARS) and can result in death, spread all over the world emerging from China. It is important to know the cases that expected to show a fatal course beforehand due to the cases resulting in death. In this study we analyzed the changes observed in ferritin, D-dimer, lymphocyte and monocyte levels, which are easily measured in patients, and evaluated how these determinants can be used as prognostic factors of the disease.
Materials and methods: One hundred patients who applied to Bezmialem Vakif University Hospital between April 2020 – May 2020, who were Covid-19 PCR positive, and had infiltration in their pulmonary computerised tomography scan, were included in the study. These patients were divided into two groups as normal service patients and intensive care unit patients. Ferritin, D-dimer, lymphocyte and monocyte levels, ALT, AST, LDH, and CRP levels were recorded at the time of diagnosis. Lymphocyte/monocyte ratio (LMR) was calculated.
Results: Ferritin and D-dimer levels, ALT, AST, LDH, and CRP levels were found to be statistically and significantly higher in the mortality group compared to non-mortality (p<0.05). LMR, on the other hand, was found to be statistically and significantly lower in the mortality group (p<0.05).
Conclusion: Ferritin, D-dimer levels and LMR can be determinant laboratory findings in the prognosis of the disease that are detected in the Covid-19 patients at the dime of diagnosis. More studies should be conducted to objectively evaluate disease-related prognostic factors.
Key words: Ferritin, D-dimer, LMR, SARS-CoV-2
Ventricular hypertrophy and ischaemic changes in Children with Sickle Cell Anaemia and its relationship with the Haemoglobin Concentration in Steady State (2021-01-09)
Objective: The prevalence and burden of Sickle Cell Anaemia (SCA) in Nigeria are high and they contribute to childhood morbidity and mortality. Chronic anaemia and vaso-occlusion usually involve different organs. The involvement of the heart is a common complication of SCA, thus the need for early detection of cardiac abnormalities in children with SCA. To assess cardiac structure using ECG in children with SCA in steady-state and to determine the relationship between abnormal ECG findings and the participants’ haemoglobin concentration.
Material and Method: It was a cross-sectional study done in one of the tertiary hospitals in southeast Nigeria. The study participants were 164 children with SCA in steady state within the ages of 2 -17 years. A 12-lead ECG was carried out on the participants and their haemoglobin concentrations determined. The relationship between the presence of cardiac abnormality and independent variables like haemoglobin concentration, age and gender were analyzed.
Result: The prevalence of cardiac abnormality was 59.1%. The commonest cardiac structure abnormality was Left ventricular hypertrophy (LVH) (39.6%). Abnormality in the P-R interval was seen in 14.6%, while ST segment abnormality was seen in 18.3%. The mean Hb of those with abnormal ECG was lower than that of those without abnormal ECG, across each age group. Severe anaemia was a significant (p< 0.01) predictor of LVH. However, there was no significant association between the degree of anaemia and the occurrence of ST-segment (p: 0.26) and PR interval abnormalities (p: 0.52).
Conclusion: Cardiac anomalies are common findings in SCA children.