COVID-19: booster(s) vs. hospitalization and Intensive Care Unit admission

OBJECTIVE

As the pandemic continues, different vaccine protocols have been implemented to maintain the protection of vaccines and to provide protection against new variants. The aim of this study was to assess hospitalized patients' vaccination status and document the efficacy of boosters.

PATIENTS AND METHODS

The patients that were hospitalized due to COVID-19 were enrolled from 28 hospitals in Turkey for five months from September 2021. 5,331 confirmed COVID-19 patients from collaborating centers were randomly enrolled to understand/estimate the distribution of vaccination status in hospitalized patients and to compare the efficacy of vaccination/booster protocols.

RESULTS

2,779 men and 2,552 women of which 2,408 (45.2%) were admitted to Intensive Care Units participated in this study. It was found that the highest risk reduction for all age groups was found in groups that received 4 doses. Four doses of vaccination for every 3.7 people under 50 years of age, for every 5.7 people in the 50-64 age group, and for every 4.3 people over 65 years of age will prevent 1 patient from being admitted to intensive care. Regardless of the type of vaccine, it was found that the risk of ICU hospitalization decreased in those who were vaccinated compared to those who were not vaccinated. Regardless of the type of vaccine, the ICU risk was found to decrease 1.25-fold in those who received 1 or 2 doses of vaccine, 1.18-fold in those who received 3 doses, and 3.26-fold in those who received 4 doses.

CONCLUSIONS

The results suggested that the addition of a fourth dose is more effective in preventing intensive unit care even in disadvantaged groups.

The association between the lymphocyte-to-monocyte ratio and coronary artery disease severity in patients with stable coronary artery disease

OBJECTIVE

Inflammation plays an important role in the pathogenesis of atherosclerosis. The lymphocyte-to-monocyte ratio (LMR) may reflect a systemic inflammatory status. We investigated the association between the LMR and coronary artery disease (CAD) in patients with stable angina pectoris.

PATIENTS AND METHODS

A total of 221 consecutive patients who had been routinely referred for coronary angiography, for stable angina pectoris and 72 patients with normal coronary arteries were included in the present study. We analyzed the relation between the LMR and the angiographic severity of CAD. The SYNTAX score (SxS) was used for assessing the severity of coronary atherosclerosis.

RESULTS

The neutrophil-to-lymphocyte ratio (N/L ratio), platelet size distribution width (PDW), neutrophil and uric acid levels were significantly higher in the stable angina pectoris group than in the control group. The LMR was significantly lower in the stable angina pectoris group than in the control group (4.5±3.2 vs. 6±2.9, p < 0.001). The MPV/L ratios were similar in both groups. Patients with elevated SYNTAX scores (>32) had lower LMR values (3.2±1.5 vs. 4.6±3, p = 0.002). The monocyte count/HDL-C ratio (MHR) was significantly higher in patients with stable CAD than in the control group (0.015±0.008 vs 0.009±0.004, p < 0.001); however, it was similar in the higher SYNTAX score (>32) and lower SYNTAX score groups (0.018±0.007 vs. 0.014±0.008, p = 0.056). Using multivariate logistic regression analysis, we found that only the LMR was an independent predictor of the high SYNTAX scores in patients with stable angina pectoris.

CONCLUSIONS

 The LMR, an inexpensive and easily measurable laboratory variable, is significantly associated with the presence of CAD and high SYNTAX scores in patients with stable angina pectoris.

Traumatic brain injury shows better functional recovery than brain tumor: a rehabilitative perspective

BACKGROUND

The similar symptoms seen in the brain tumor (BT) and traumatic brain injury (TBI) population. However, functional comparisons between these two diagnostic groups have been limited.

AIM

To compare functional outcomes in patients with supratentorial BT and TBI after early rehabilitation.

DESIGN

This was a retrospective database analysis. Setting. Patients admitted to an Acute Care Unit as inpatient (Hacettepe Hospital, Ankara-Turkey). Population. The population included patients with BT and TBI.

METHODS

Thirty-four patients with BT and TBI were matched one-to-one by lesion side and sex. The Barthel Index was used to assess functional status at the pre- and postrehabilitation. The change rate and efficiency in BI were also calculated. The time between injury onset and admission to rehabilitation (the onset to admission interval, OAI) and length of stay in rehabilitation (LOS rehab) were recorded. In addition, the influence of lesion side (left and right) and age on functional outcome were analyzed.

RESULTS

The functional level was significantly lower in TBI patients than in patients BT before rehabilitation (P<0.05). The post-rehabilitation BI score was similar in patients with BT and TBI (P>0.05). Patients with TBI had greater the change rate and efficiency in BI (P<0.05). The OAI and LOS rehab was longer in patients with TBI (P<0.05). In terms of lesion side comparisons, no differences were found (P>0.05). The age had no effect on functional outcome in patients with TBI and BT (P>0.05), expect the age group 45-59 (P<0.05).

CONCLUSION

The early rehabilitation program improved functional ability of patients with brain tumors, as well as patients with traumatic brain injury. Despite the lower functional status, patients with TBI displayed better functional recovery than patients with BT. Lesion side had no effect on functional outcome in patients with TBI and BT. Differences in functional status begin to appear even in patients with TBI between 45 and 59 years. Further investigations with more detailed outcome instruments are required to better understand the qualitative limitations of a patient's recovery.

CLINICAL REHABILITATION IMPACT

Patients with TBI will make functional gains comparable with patients with brain tumors in a similar rehabilitation setting.

Combined Therapy of Teicoplanin and Caffeic Acid Phenethyl Ester (CAPE) in the Treatment of Experimental Mediastinitis in the Rat

Post-sternotomy mediastinitis affects 1-3% of patients undergoing cardiac surgery and is lethal in 10-47% of these patients. We investigated the effect of an antioxidant/anti-inflammatory agent, caffeic acid phenethyl ester (CAPE), in the attenuation of inflammatory response induced by methicillin-resistant Staphylococcus aureus (MRSA) infection in a rat experimental mediastinitis model. Rats, divided into six equal groups, received MRSA precolonized stainless steel wire pieces implanted into their mediastinal spaces. Control group and CAPE control group received saline and CAPE 10 micromol/kg.day(-1 )respectively, where Group A received a single dose of teicoplanin 24 mg/kg i.m. for the first day and then 12 mg/kg.day(-1) . Group B received teicoplanin as in Group A plus CAPE 10 micromol/kg. day(-1 )intra-peritoneally. Group C received teicoplanin 60 mg/kg i.m. for the first day and then 30 mg/kg.day(-1 )and Group D received teicoplanin as in Group C plus CAPE 10 micromol/kg.day(-1) . By the end of 14 days rats were sacrificed and serum malondialdehyde (MDA), myeloperoxidase (MPO), nitric oxide (NO), urea and creatinine levels were evaluated. Mediastinal organ tissues were collected for histopathological analysis. Infection rates in all the drug-treated groups were lower than the control groups ( P=0.002) but statistical significance was attained only between the groups A and D ( P=0.018). In connective tissues and the peribronchial area polymorphonuclear leukocytic (PNL) infiltration in the treatment groups, although becoming very close, did not reach statistical significance (P =0.053, P=0.075, respectively). PNL infiltration especially in the peribronchial tissues of the Group B animals was found to be significantly less than the Control and CAPE Control groups with P values of 0.013 and 0.010, respectively. MDA and MPO levels were significantly lower in the treatment groups ( P<0.001 and P<0.001 respectively). Levels of the degradation products of NO were lower in treatment groups compared to two control groups (P=0.003, P= 0.005). NO levels in Group D were lowest among all treatment groups ( P=0.001). It has been demonstrated that although bacterial colonization can be controlled in mediastinitis, the inflammatory response persists. The combination of an antioxidant / anti-inflammatory agent, CAPE, added to standard antibiotic therapy might be effective in the treatment of post-sternotomy mediastinitis due to MRSA.

Long-term follow-up of laparoscopic electrocautery of the ovaries versus ovulation induction with recombinant FSH in clomiphene citrate-resistant women with polycystic ovary syndrome: an economic evaluation

BACKGROUND

Laparoscopic electrocautery of the ovaries and ovulation induction with gonadotrophins are both second line treatments for women with clomiphene citrate-resistant polycystic ovary syndrome (PCOS). Long-term follow-up after electrocautery versus ovulation induction with gonadotrophins has demonstrated at least comparable chances for a first live born child with a reduced need for ovulation induction or assisted reproduction treatment and increased chances for a second live born child. In this study, we report on the long-term economic consequences of both treatment modalities.

METHODS

Between February 1998 and October 2001, we performed a multi-centre randomized controlled trial (RCT) comparing a strategy of laparoscopic electrocautery of the ovaries, followed by clomiphene citrate and gonadotrophins when anovulation persisted, and a strategy of ovulation induction with gonadotrophins in women with clomiphene citrate-resistant PCOS. Eight to twelve years after randomization we performed a follow-up study on reproductive outcome in these women and the fertility treatments they had needed including data on direct medical costs of pregnancy and delivery. Clinical data included number of treatment cycles, live births, miscarriages, ectopic pregnancies and multiple pregnancies. We calculated mean costs per woman after randomization until the first live birth. Confidence intervals (CIs) were estimated by bootstrapping.

RESULTS

We obtained data for an economic analysis on 159 of the 168 randomized women (95%). In total, 71 of 83 women (86%) allocated to the electrocautery strategy and 69 of 85 women (81%) allocated to the gonadotrophin strategy had at least one live birth. Given the equivalence between the two treatment strategies in terms of a first live birth-the primary outcome measure-our analysis focused on the cost difference between the two strategies within a mean follow-up time of 8-12 years. The mean costs per first live birth after randomization were €11 176 (95% CI: €9689-€12 549) for the electrocautery group and €14 423 (95% CI: €12 239-€16 606) for the recombinant FSH group, resulting in significantly lower costs (P < 0.05) per first live birth for women allocated to the electrocautery group (mean difference €3247; 95% CI: €650-€5814).

CONCLUSION

In women with clomiphene-resistant PCOS, laparoscopic electrocautery of the ovaries results in significantly lower costs per live birth than ovulation induction with gonadotrophins for an at least equal effectiveness.

Potential of various drugs to inhibit nucleoside uptake in rat syncytiotrophoblast cell line, TR-TBT 18d-1

The placenta requires nucleosides as nutrients for fetal growth, so it is important to examine potential interactions between placental transports of nucleosides and drugs to ensure the safety of pharmacotherapy during pregnancy. The purposes of this study are to clarify the uptake mechanisms of nucleosides from the maternal side of the syncytiotrophoblast and to investigate the inhibitory effect of various drugs on nucleoside uptake, using the rat syncytiotrophoblast cell line TR-TBT 18d-1, which shows syncytial-like morphology and functional expression of several transporters. Initial uptake of [(3)H]uridine or [(3)H]adenosine from the apical side of TR-TBT 18d-1 was markedly reduced by an excess of the respective unlabelled compound, and was slightly reduced by replacement of Na(+) with N-methyl-d-glucamine, indicating that both uptakes were Na(+)-independent. [(3)H]Uridine and [(3)H]adenosine uptakes in the absence of Na(+) were significantly and concentration-dependently inhibited by both 0.1 microM and 100 microM nitrobenzylthioinosine, suggesting the involvement of equilibrative nucleoside transporters (ENTs, SLC29). Kinetic analysis of adenosine uptake yielded a K(m) value of approximately 17 microM. These results are consistent with the reported uptake characteristics of uridine and adenosine by ENT1 and ENT2. The uptakes were significantly reduced by high concentrations of several nucleoside drugs, including cytarabine, vidarabine, zidovudine, mizoribine, caffeine and amitriptyline, but the effects were small within the therapeutic concentration ranges. In summary, our results suggest that ENTs are involved in apical uptake of uridine and adenosine in the syncytiotrophoblast. However, therapeutic concentrations of the drugs tested in this study might have little influence on maternal-to-fetal nucleoside transfer.

Altered expression of basement membrane-related molecules in rat brain pericyte, endothelial, and astrocyte cell lines after transforming growth factor-beta1 treatment

The basement membrane at the blood-brain barrier (BBB) plays important roles in maintaining the structure and function of capillary vessels. The BBB is constructed from endothelial cells, astrocytes and pericytes, but their interactions in the formation or maintenance of basement membrane have not been established. Transforming growth factor-beta1 (TGF-beta1) is known to increase fibronectin in brain capillary basement membrane with deposition of beta-amyloid. We previously reported that the mRNA level of alpha-smooth muscle actin in a brain capillary pericyte cell line TR-PCT1 was increased by treatment with TGF-beta1. In this study, expression of mRNAs encoding basement membrane-related molecules in TR-PCT1, a rat endothelial cell line TR-BBB13, and a type 2 astrocyte cell line TR-AST4 was evaluated by RT-PCR. The effects of TGF-beta1 on expression of basement membrane-related genes in these cell lines were also examined. Fibronectin, MMP-9, tPA, TIMP-1, and PAI-l in TR-PCT1 were higher than in TR-BBB13 and TR-AST4. In TR-PCT1 treated with TGF-beta1, collagen type IV, PAI-1, and MMP-9 were increased, and TIMP-2 was reduced. The change in PAI-1 mRNA was faster than those in MMP-9, TIMP-2, collagen type IV mRNAs. These results suggest that pericytes may be key cells in the maintenance of the basement membrane at the BBB.

Prediction of Theophylline Clearance in CCl4-treated Rats Using in vivo CYP1A2 and CYP3A2 Contents Assessed with the PKCYP Test

We previously established a method to predict the drug metabolism capacity of injured liver based on pharmacokinetic estimation of the amount of cytochrome P450 (CYP) in vivo (PKCYP test), by introducing the apparent liver-to-blood free concentration gradient in vivo (qg) as a parameter. Here we show that the amount of CYP3A2 in CCl(4)-treated rats can be estimated appropriately by applying the PKCYP test using midazolam (MDZ) as a probe, assuming that the qg value in control rats does not change. We applied the results to predict the clearance of theophylline as a model drug with a physiologically based pharmacokinetic model. Male Sprague-Dawley rats were pretreated with CCl4, and the amount of CYP (A-CYP(vivo)) was quantified by Western blotting. The qg value of MDZ was determined in control rats and used to estimate the amounts of CYP3A2 in CCl4-treated rats; the result agreed well with the observed values. The qg value of CYP3A2 estimated with MDZ as a probe was used together with our previously reported value for CYP1A2 (theophylline metabolism in the liver is known to be almost entirely mediated by CYP3A2 and CYP1A2) to predict the total body clearance (CL(tot)) of theophylline in CCl4-treated rats. The predicted CL(tot) was about one-third of the observed value, which was considered acceptable. The time-course of theophylline concentration in serum simulated with a physiologically-based pharmacokinetic model agreed well with the observed values. Thus, the PKCYP test using MDZ as a probe can be used to predict the amount of CYP3A2 and the CL(tot) of theophylline in CCl4-treated rats.

Left ventricular outflow tract myxoma

This article reports a left ventricular outflow tract (LVOT) myxoma, presenting with peripheral embolus, in a 90-year-old patient during the follow-up due to ischemic heart disease. Among LVOT myxomas, which are usually very rare and most likely to present with manifestations due to obstruction, this is the first case presenting with peripheral embolus. In this study, diagnosis was based on the histopathological evaluation of the embolectomy material. The report emphasizes the importance of evaluation of the embolectomy material in appropriate patients who present with peripheral emboli, and where an intracardiac mass is suspected.

[A case of Behçet disease associated with hepatocellular carcinoma]

A 31-year-old man, suffering from Behçet disease, was admitted to our hospital because of a palpable mass in the right hypochondrium. On testing, laboratory data showed an abnormal liver function, positive HBs antigens, and a high AFP level. An abdominal CT and a SCAG revealed large tumors in the liver. The patient died of hepatic failure 6 months after the first admission and an autopsy was performed. At autopsy, hepatocellular carcinomas were found to occupy most of the entire liver. Histologically, the residual liver showed no remarkable changes, such as liver cirrhosis or chronic hepatitis. To date, few cases of Behçet disease complicating a malignant neoplasma have been reported. The possible relationship between Behçet disease and the occurrence of malignant tumors is described with a review of the literature.