Although initial data on intestinal obstructions are based on Hippocrates, there is still no consensus on approaches today. However, parallel to the development of medical technology and the increasing experience of us surgeons, morbidity and mortality rates due to intestinal obstruction have decreased. Obstruction can occur at any point in the gastrointestinal tract. The main thing is to make a correct diagnosis and to treat the patient in the most correct way. Intestinal obstructions usually present with colic abdominal pain, nausea, vomiting, and constipation. Intestinal obstructions may be present due to various reasons. Surgeons have an important role in preventive mechanical obstructions due to adhesions. Patients must be hospitalized. If there is no emergency surgical indication, conservative methods can be applied. Patients should be mobilized early, and fluid-electrolyte balance should be adjusted and followed closely.
Introduction Oral anticoagulants (OAs) are not in routine use during
Coronavirus disease (COVID-19). Studies that compare the COVID-19
infection outcome of chronic OA users with their peers of non-OA users
are available. To the best of our knowledge, none of these studies
evaluated the effect of OA use on the COVID-19 related early admission
laboratory parameters and/or length of the hospital stay. So, we will
study these here. Methods This retrospective study was included 2
groups; group 1 (n=62) consisted of OA users, and group 2 (n=75) of age,
and sex-matched of OA non-users at the time of COVID-19 diagnosis. Early
admission laboratory measures, numbers of comorbidities, length of
hospital stay, and outcomes of these patients were recorded and analyzed
Results Despite higher numbers of comorbidities in group 1, their serum
CRP and D-dimer levels were significantly lower than the group 2.
(p<0.05, all). The rate of mortality was higher in group 2
patients, but, it has not reached a statistical significance
(p>0.05). Regression analysis showed that OA users (in
comparison to non-OA users) had 0.980 and 0.520 times lower serum CRP
and D-dimer levels, respectively. Conclusions This study showed a
beneficial effect of OA use on early admission serum CRP, and D-dimer
levels, which are important prognostic predictors in COVID-19.
Additionally, OA use associated with lesser hospital stay days of
COVID-19 patients. These beneficial effects of OA use might help in
improving the management of this infection after further dedicated
studies in this field.
Wegener's Granulomatosis is one of the ANCA-associated vasculitis characterized by multifocal vascular necrotizing inflammation and granulomas that commonly present with a pulmonary-renal syndrome. We report a case of 38 year-old female patient who presented with acute respiratory distress syndrome due to diffuse alveolar hemorrhage and multiorgan failure. The patient being in a hemodynamic collapse was aggressively intubated and supported by mechanical ventilation and vasopressor therapy. Despite all effort refractory hypoxemia could not be coped with. Venovenous extracorporeal membrane oxygenation was started through a femoral and jugular vein. Her oxygenation dramatically ameliorated after the beginning of this procedure. 1 gr/day pulse metylprednisolone was administered followed by cyclophosphamide. Concurrent continious renal replacement therapy and plasmapheresis was begun. Her clinical status improved in days giving rise to weaning of the extracorporeal membrane oxygenation by the day twelve. Extracorporeal membrane oxygenation is reported to be a successful mode of therapy in various cases in the literature including diffuse alveolar hemorrhage due to ANCA-associated vasculitis and concurrent therapy with continuous venovenous hemodialysis is reported to increase survival. Clinicians should be encouraged to use this life saving mode of treatment more often.
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