Aim: We aimed to identify dislocation, myelomalacia, and other congenital pathologies that may cause neurological complications arising from the odontoid process in the craniocervical junction (CVJ) of patients who were performed cervical tomography due to various complaints. Materials and Methods: Patients who were performed cervical CT with various complaints between 2010 and 2018 were retrospectively screened and evaluated, from the hospital registry system. Segmentation and fusion anomalies arising from the odontoid process in the craniovertebral junction area, as well as other accompanying pathologies such as subluxation, dislocation, compression to the spinal cord, and myelomalacia were also recorded. An additional 1.5 Tesla cervical MRI was performed for the 12 patients with os odontoideum. Radiological evaluation was performed on the workstation by an experienced radiologist. Results: 2525 patients with cervical CT were included in the study. 67 of these patients had congenital anomalies at the CVJ. 13 of 67 patients had os odontoideum, 38 had Klippel-Feil syndrome (KFS). Atlanto-occipital assimilation (AOA) and KFS often saw together. Only AOA was observed in 16 cases. Neck pain and limitation of movement were the most common findings in patients with congenital anomalies in the CVJ region. Conclusion: Congenital anomalies at the CVJ region, although rare, can cause mortality or morbidity. Cervical CT and MRI studies on the CVJ region should be evaluated carefully by the clinicians due to the risk of various complications.

BACKGROUND. Histological evaluation has a crucial role in diagnosing hepatic diseases and percutaneous liver biopsy (PLB) is widely chosen for this purpose. We aim to describe its indications, the rate and severity of adverse events (AEs) in an outpatient and ultrasound (US)-guided setting over 5 years. METHODS. This observational, single-center, and retrospective study included patients submitted to PLB between 2015 and 2019. We collected age, gender, coagulation tests, comorbidities, and number of needle passes. The association between the variables and outcomes (pain, mild and serious AEs, hospital admission, surgical treatment, and death) was evaluated using the generalized estimating equations method. RESULTS. We analyzed 532 biopsies in 524 patients (55.3% male) aged 49y (13–74y). Almost 39% had cardiovascular comorbidities and 18% had overweight/obesity. Hepatitis C virus (HCV) chronic infection was the major indication for PLB (47%), followed by autoimmune hepatitis/cholestasis (12.6%), and metabolic dysfunction-associated fatty liver disease (MAFLD) (12.1%). The number of HCV-related biopsies had a remarkable reduction, while MAFLD-related procedures have progressively raised over time. Around 54% of the patients reported pain, which was significantly associated with the female gender (p=0.0143). Serious AEs occurred in 11 patients (2.1%); hospital admission was necessary in 10 cases (1.9%), but no patient required surgical approach and there were no deaths. No significant association was found between the occurrence of AEs and the studied variables (clinical, laboratory, and number of needle passes). CONCLUSION. Real-time US-guided PLB is safe to perform in an outpatient setting and its indications have notably undergone a transition from HCV to MAFLD over the years. New strategies to prevent biopsy-related pain are still needed, especially for females.

Introduction: Early recognition of critical patients is crucial in emergency departments. Many scoring systems are used for it. This study aim determining the prognostic values of these scoring systems for Covid 19 patients. Method: This retrospective study was performed between March 2020 -May 2020. 212 patient who have Covid 19 pneumonia were enrolled the study. National Early Warning Score (NEWS), Modified Early Warning Score (MEWS) and quick Sequential Organ Failure Assessment (qSOFA) scores were calculated according to patients’ admission data. Receiver operating characteristic (ROC) analysis was used to determine the diagnostic values of scores and the optimum cut-off values were determined by using Youden Index.Results: 23 (10.8%) of 212 patients died and 34 (16%) were admitted to ICU. The AUC values of MEWS, NEWS, and qSOFA for predicting mortality in < 65 years old were 0.852 (95% confidence interval 0.708-0.997), 0.882(0.741-1.000) and 0.879(0.768-0.990) and >65 years old 0.854(0.720-0.987), 0.931(0.853-1.000), 0.776(0.609-0.944) respectively. For ICU admission AUC values of MEWS, NEWS and qSOFA in <65 years old followed as; 0.882(0.783-0.981), 0.914(0.817-1.000), 0.868(0.764-0.973) and 0.845(0.725-0.965), 0.926(0.854-0.998), 0.815(0.676-0.954) in ≥ 65 years old. MEWS and qSOFA’s optimal cut-off values for mortality were ≥2 with %90.0 sensitivity %74.7 specificity and ≥1 with %90.0 sensitivity %74.7 specificity for <65 years, NEWS optimal cut-off is ≥6 with 91.7% sensitivity and 76.7% specificity for ≥ 65 years old.Conclusion: These scores have good predictive value for mortality and ICU admission, but NEWS is better especially in ≥ 65 years old patient with Covid 19 pneumonia.Keywords: Early warning scores, NEWS, MEWS, qSOFA, Covid 19 pneumonia, mortality

Aim To evaluate consecutive measurements of the biometric parameters, age, and refraction error in a Turkish population at primary school age. Materials and Methods A total of 197 children aged between 7-12 years were included. The data of three consecutive measurements of children, who were examined at least once a year for three years using both cycloplegic auto-refractometry and optical biometry, were used in this retrospective study. Spherical equivalent <-0.50D was considered to be myopic; >+0.75D was considered to be hypermetropic. Age, gender, body mass index, spherical equivalent, axial length, anterior chamber depth, central corneal thickness, keratometry, and lens thickness were analyzed. The onset data obtained in 2013 whereas, the final data were from 2015. Logistic and Cox regression analyses were performed (p<0.05). Results The mean of the onset and the final spherical equivalents were 0.19D (0.56), and 0.08D (0.80), respectively. The myopia prevalence was increased among refractive errors in observation periods (univariable analysis p=0.029; multivariable analysis p=0.017). The onset axial length (HR:4.55, 95%CI:2.87-7.24, p<0.001), keratometry (HR:2.04, 95%CI:1.55-2.67, p<0.001) and age (HR:0.73, 95%CI: 0.57-0.92, p=0.009) correlated myopia progression. To calculate the estimated spherical equivalent, the onset data were included in the logistic regression model. The onset data of spherical equivalent (β=0.916, p<0.001), axial length (β=-0.451, p<0.001), anterior chamber depth (β=0.430, p=0.005) and keratometry (β=-0.172, p<0.001) were found to be significantly associated with the mean SE at the final data. Conclusions To calculate the estimated spherical equivalent following three years, an equation was proposed. The estimated refractive error of children can be calculated by using the proposed equation with the associated onset optical parameters.

Background: Data directly comparing trends in the use of different oral anticoagulants (OACs) among patients with atrial fibrillation (AF) from different countries are limited. We addressed this using a large-scale network cohort study in the United States (US), Belgium, France, Germany and United Kingdom (UK). Methods: We used nine databases (claims or electronic health records) that had been converted into the Observational Medical Outcomes Partnership Common Data Model with analysis performed using open-source analytical tools. We identified adults with AF and a first OAC prescription, either vitamin K antagonist (VKA) or direct oral anticoagulant (DOAC) from 2010–2017. We described time-trends in use, continuation and switching. Results: In 2010, 87.5%–99.8% of patients started on a VKA. By 2017, the majority started on a DOAC: 87.0% (US), 88.3% (Belgium), 93.1% (France), 88.4% (Germany), 86.1%–86.7% (UK). In the UK, DOACs became the most common starting OAC in 2015, 2–3 years later than elsewhere. Apixaban was the most common starting OAC by 2017: 50.2%–57.8% (US), 31.4% (Belgium), 45.9% (France), 39.5% (Germany), 49.8%– 50.5% (UK), followed by rivaroxaban; 24.8%–32.5% (US), 25.7% (Belgium), 38.4% (France), 24.9% (Germany), 30.2%– 31.2% (UK). Long-term treatment was less common in the US than in Europe, especially the UK. A minority of patients switched from their index OAC, both in the short- and long-term. Conclusions: From 2010–2017, VKA use had significantly declined and DOAC use had significantly increased in the US and Europe; apixaban was the most prescribed OAC in 2017 followed by rivaroxaban.

Background: The aim of this study is to evaluate the importance of ischemia changed albumin, in foreseeing fetal asphyxia and comparing it between normal and preeclamptic pregnant. Method: We planned our study as a prospective case-controlled study between May 2011 and June 2013. We recruited 104 pregnant women complicated by preeclampsia and 110 healthy pregnant women in the study. Doppler ultrasonography, non-stress test and fetal biometric measurements were performed. Venous blood samples taken to measure ischemia modified albumin (IMA). The presence of fetal hypoxia/acidosis was analyzed by conducting post-natal cord blood gas examination and 1.-5. minutes APGAR scoring. Results: IMA levels in the preeclamptic group were found statistically high (p<0,0001). The correlations between umbilical artery doppler systolic/diastolic (S/D) ratio, brain sparing effect, non stress test and IMA analyzed. We have found IMA statistically high when S/D ratio is above 2 standard deviations (preeclampsia; 11.83±1.33 vs 19.62±1.56 p<0.001, control; 10.28±1.57 vs 18.09±2.13 p<0.001) or brain sparing effect started (preeclampsia; 25.59±2.48 vs 9.16±1.99 p<0.001, control; 16.37±1.97 vs 6.72± 1.53 p<0.001) or abnormal NST findings occurred (preeclampsia; 10.69±1.92 vs 20.72±1.15 p<0.001, control; 7,42±1,94 vs 9,72±2,19 p<0.001). Conclusions: Maternal IMA levels are found high in preeclamptic pregnant women and it can be used as a biomarker for determining fetal wellbeing. What’s already known about this topic? Hypertensive disease of pregnancy is the most frequently complication of pregnancy, being 5-10%. It is the most important reason for perinatal morbidity and mortality. Preeclampsia develops in an abnormal hypoxic intrauterine environment characterized by reperfusion and oxidative stress. To determine the fetal wellbeing, various tests were suggested, yet many of them provided a few benefits. What does this article add? The detected elevations in serum concentrations of IMA propose that measurements of this biomarker may be useful in assessing fetal hypoxia and predicting pregnancies which preeclampsia may develop

Objective: Muscular dystrophies refers to a group of primary inherited myopathies that exhibit a chronic and unremitting progressive course. Quality of life is a concept, which mainly reflects individual responses given by a person to the physical, psychological, social and environmental impacts of the disease. In this study we aimed to evaluate quality of life and sociodemographic features of 146 patients who presented to the physical therapy and rehabilitation neuromuscular diseases outpatient clinic of our hospital. Methods: Patients’ sociodemographic data including gender, marital status and educational level were recorded and analyzed. WHOQOL-BREF survey was performed in order to determine quality of life in patients with muscular dystrophy. The scores obtained from the survey were transformed into WHOQOL 4-20 and WHOQOL 0-100 score ranges, and relationships between the sociodemographic data of the patients and WHOQOL-BRIEF survey results were evaluated. Results: Eighty-five (58.2%) patients were male and 61 (41.8%) were female. No statistically significant difference was found between the male and female MD patients in terms of the physical, psychological, social relationships and environmental domains of WHOQOL-BREF scale (for all p>0.05). No significant difference was found between single, married, divorced and widowed patients (for all p>0.05). There were significant differences between educational levels of the patients in terms of the mean WHOQOL-BREF scores (p<0.05). The mean scores increased as educational levels increased. Conclusion: Quality of life increases with the levels of education and does not differ according to gender and marital status in patients with muscular dystrophy. Patients with muscular dystrophy should be encouraged for education from the pediatric period.

Background: Takotsubo Syndrome (TTS) is characterized by acute and reversible left ventricular dysfunction with apical ballooning arising during acute stress situations. Acute Ischemic Stroke (AIS) is one of the known triggers to TTS, however, the impact of TTS on in-hospital outcomes of AIS remains unexplored. Methods: We utilized data from the National Inpatient Sample (2007-2014) and using ICD-9-CM diagnosis codes to identify admissions for AIS with TTS and evaluated the temporal trends, baseline characteristics, in-hospital complications, length of stay (LOS) and all-cause mortality. Survey multivariable logistic regression was used to compute adjusted Odds Ratios (OR and 95% confidence intervals (CI). Results: An estimated 2,242 (0.4%) TTS cases were identified among AIS hospitalizations (N=43,92,471). The frequency of TTS was higher in elderly, whites and females (82.2%). After adjustment for confounders, TTS incidence in AIS was associated with higher odds of in-hospital complications including cardiogenic shock (OR8.84, CI:4.07-19.17, p<0.001), cardiac arrest (OR3.17, CI:1.57-6.42, p=0.001), and venous thromboembolism (OR1.68, CI:1.14-2.47, p=0.008). Moreover, AIS hospitalizations with TTS showed higher odds of developing respiratory failure (OR3.13, CI:2.42-4.05, p<0.001) and required mechanical ventilation/intubation (OR4.09, CI:3.14-5.32, p<0.001) more frequently compared to non-TTS cohort. The AIS-TTS cohort had longer LOS (8.59 vs 5.22 days) and the mortality was doubled (10.2% vs 5.1% p<0.001) compared to those without TTS. Conclusion: The prevalence of TTS in AIS remained ~20 times higher than the general inpatient population and it predisposed AIS patients to worse inpatient outcomes. Further studies are needed to evaluate the impact of TTS on long-term outcomes in AIS.

Objective: This study aimed to assess the possible role of dermoscopy in the diagnosis of different nail disorders compared with the clinical and histopathological diagnosis. Methods: This study included 104 patients with any nail disorders of both sex and any age. All the patients were subjected to a detailed medical history taken, clinical general examination, clinical and dermoscopic examinations of 20 nails. Potassium hydroxide examination was used to examine all patients with suspicious of onychomycosis. Histopathological evaluation was used to examine of clinically ambiguous nail disorders. Results: The most common nail diseases were onychomycosis (54.81%) followed by nail psoriasis (19.2%), and nail lichen planus (3.8%). Conclusion: Clinical evaluation was an important in diagnosis of different nail diseases. Nail dermoscopy could confirm clinical diagnosis and help in getting an accurate diagnosis of nail diseases and guide in the management of nail diseases by permitting better visualization of nail structure and pathology. Histopathological examination provided the most definitive method in reaching an accurate diagnosis due to it could provide etiologic, diagnostic, and prognostic information. There was good agreement between clinical, dermoscopic, and histopathological examinations for accurate diagnosis of different nail diseases.

Aim: To determine the efficacy of neutrophil/lymphocyte ratio (NLR) as a marker of the severity of COVID-19 pneumonia in the South-Asian population. Methods: This was a prospective, cross-sectional, analytic study conducted at HDU/ICU of District Headquarter Hospital, Faisalabad, Pakistan, from May through July 2020. Sixty-three eligible patients, admitted to the HDU/ICU, were prospectively enrolled in the study. Their NLR, C-reactive protein, serum albumin, and serum fibrinogen were measured. Patients’ demographic characteristics, comorbidities, clinical manifestations of COVID-19 infection, medication use, and history of lung malignancy were retrieved from their medical history. Patients were categorized into either a general group (with mild COVID-19) or a heavy group (with moderate to severe COVID-19). Results: There were significant differences between the two groups in diabetes prevalence, NLR, C-reactive protein, and serum albumin. NLR and C-reactive protein were positively correlated (P < 0.001, P = 0.04 respectively) whereas serum albumin was negatively correlated (P = 0.009) with severe COVID-19. NLR was found to be an independent risk factor for severe COVID-19 pneumonia in the heavy group (OR = 1.264, 95% CI: 1.046~1.526, P = 0.015). The calculated AUC using ROC for NLR was 0.831, with an optimal limit of 4.795, sensitivity of 0.83 and specificity of 0.75, which is highly suggestive of NLR being a marker for early detection of deteriorating severe COVID-19 infection. Conclusion: NLR can be used as an early warning signal for deteriorating severe COVID-19 infection and can provide an objective basis for early identification and management of severe COVID-19 pneumonia.

Aim: To assess effect of high-dose vitamin C on cardiac injury in coronavirus disease 2019 (COVID-19). Methods: The study was designed based on the severe and critically ill COVID-19 with cardiac injury. Demographics and baseline clinical characteristics were collected and analyzed in addition to laboratory examinations including inflammatory markers on admission and at 14 days after treatment from the electronic medical records. Participants were followed-up for 14 days after treatment with high-dose vitamin C in addition to conventional therapy. Result: The patients (n = 113) were categorized into the improved cardiac injury (ICI) group (n = 70) and the non-improved cardiac injury (NICI) group (n = 43). Overall, 51 (45.1%) patients were administrated with high-dose vitamin C, the percentages of patients treated with high-dose vitamin C were higher in the ICI group than that in the NICI group (52.8% vs 32.5%, P = 0.035). Further analysis showed that concentrations of high-sensitivity C-reactive protein (hs-CRP), tumor necrosis factor (TNF)-α, interleukin-2 receptor (IL-2R), IL-6 and IL-8 significantly decreased at 14 days after treatment in patients treated with high-dose vitamin C compared with those in patients administrated without high-dose vitamin C. Meanwhile, similar results were also observed regarding changes in inflammatory markers from baseline to 14 days after treatment in patients receiving high-dose vitamin C. Conclusion: High-dose vitamin C can improve cardiac injury through preventing hyper-inflammatory response in severe and critically ill COVID-19.

PURPOSE: To observe the effect of phacoemulsification and intraocular lens (IOL) implantation with or without lens capsular tension ring (CTR) on retinitis pigmentosa (RP) combined with cataract patients. DESIGN: Retrospective cases series study. METHODS: 63cases (84 eyes) of RP with cataract were collected including 30 males and 33 females. Phacoemulsification with 3.0mm clear corneal incision was performed in all the patients. IOL+CTR implantation was performed in 44 eyes, and only IOL implantation was performed in 40 eyes. All cases were followed up at 1 week and 1, 3, 6 months after the surgery to compare the best corrected visual acuity (BCVA), intraocular pressure (IOP), corneal endothelial cell count and complications before and after the surgery. RESULTS: all surgery were successfully completed by the same physician, and IOL and CTR were all implanted in capsule without complications. The BCVA at 6 months after surgery was 0.91±0.88 LogMAR. It improved a little compared with the BCVA(1.3±0.7LogMAR) before surgery and there was a signifcant difference in statistic(P=0.003). Four cases of capsule contraction syndrome(CCS) occurred in no CTR implantation group and there was no CCS in CTR group. There was signifcant difference in statistic about the incidence of CCS between two groups(P=0.047). CONCLUSIONS: Phacoemulsification for RP combined with cataract is safe and reliable, and CTR implantation is helpful to reduce the complications caused by capsule contraction.

Hydatid cyst is an endemic disease especially in underdeveloped and developing countries affecting mostly the liver and lungs. However, a wide range of unusual anatomical sites in the abdomen has been reported, including the spleen, pancreas, kidney, and ovaries as well as dissemination within the abdominal and pelvic cavities. The location of hydatid disease in the colon is very infrequent, and very few cases have been presented. The hydatid cysts located in other sites are mostly due to rupture or extrusion of primary liver or splenic cysts. In this article, we present a case of primary left-sided colon hydatid cyst, resected laparoscopically with the affected intestinal segment. The diagnosis of hydatid cyst was made by macroscopic and microscopic examination.

Vitamin D has long been known to be a major regulator for both the endocrine and the immune system. With the advent of COVID-19 pandemic, there has been a growing interest in looking at the feasibility of using vitamin D as a preventative and therapeutic option in the management of the disease. A low serum level of vitamin D is linked to higher incidence of respiratory tract infection and disease progression. Vitamin D supplementation has proven to be effective in enhancing the immune system, strengthen lung epithelial barrier, and prevention of unchecked inflammatory response. Previous studies on the roles of vitamin D in managing influenza and other enveloped virus infection could shed light on the possible roles of vitamin D in the current pandemic. More randomised controlled trials are needed to explore the effects of vitamin D supplementation on COVID-19 infection.

The aim of this meta-analysis is to investigate the effectiveness of chloroquine in treating coronavirus, in general not only novel coronavirus (COVID¬-19), by pooling the results of randomized controlled clinical trials (RCTs). Only 28 publications were identified; none of which was a RCT. Identified studies were published between 1987 and March 15, 2020. Of these 28 publications, 7 were published in 2020 and discussed the effectiveness of chloroquine against COVID-19. In conclusion, this meta-analysis could not prove that chloroquine is an effective treatment against coronavirus in general or COVID-19 in particular. Expanded access trials should be encouraged especially that chloroquine is available, cheap and relatively safe drug.

Objectives: To analyze the current condition of the urgent neurologic in-hospital consultations, which may help junior doctors to manage diseases related to neurology and carry out emergency consultation. Methods: We conducted a retrospective study of urgent neurologic in-hospital consultations in a large tertiary hospital for four consecutive years (Jan 1, 2014 to Dec 31, 2017). Through the electronic medical record system, the clinical data of patients who received in-patient consultation in emergency neurology department were reviewed and analyzed. Results: A total of 1,437 cases (age range 9 to 103 years old with average age 60.3-year old, Male 54.6%) were included in the study, 57.5% of cases met the urgent consultation criteria. The departments applying for urgent consultation involved 29 clinical departments. The most common reasons of urgent consultation were disturbance of consciousness (36.0%), tic/stiffness (13.6%), limb weakness (8%) and mental disorders (5.6%).Urgent consultation diseases were divided into three categories: neurological diseases (77.8%), non-neurological diseases (10.4%), and unknown diseases (11.8%).Common neurological disorders were urgent cerebrovascular disease (33.6%), epilepsy/status epilepticus (15.8%), and metabolic or infection, toxic encephalopathy (14.9%). Conclusions: Most cases of the urgent neurologic consultation met the urgent neurologic consultation criteria. Non-neurologic junior physicians should clinically enrich their knowledge of neurological diseases.

Purpose: High altitude pulmonary edema (HAPE) has rapid onset and development, and may be life-threatening if not treated in time. It is important to correctly identify and recognize the characteristics of HAPE and to provide timely treatment. We aimed to summarize the characteristics of patients with HAPE by analyzing their general information, clinical symptoms, examination and laboratory results. Methods: 429 HAPE patients were enrolled in our study, and 200 of them were divided into three groups according to the period from their arrival in Naqu to the onset of the disease. We collected and analyzed the demographic information, results of laboratory tests, imaging and electrocardiography of all the participants at admission. The patients’ results of laboratory tests and imaging at admission were compared with those at discharge. The results of blood routine were compared among different groups. Results: Most of the HAPE patients were male (90.21%). The average white blood cell and neutrophil counts, alanine aminotransferase and aspartate aminotransferase levels, uric acid level, lactic dehydrogenase and creatine kinase levels were increased among HAPE patients at admission. The counts of white blood cell, neutrophil and lymphocyte, and the concentration of hemoglobin in HAPE patients at admission were higher than those at discharge (p<0.05).The counts of white blood cell and neutrophil were higher in the patients who developed the disease within 1 day than in those who developed the disease in more than 7 days (p<0.05). Conclusion: The proportion of males in HAPE patients was higher. Hepatocyte and myocardium in HAPE patients were more likely to be damaged. The white blood cell and neutrophil counts were significantly higher than normal range, and their increment was reduced as the incubation period extended.