Comorbid Conditions in a Cohort of Inpatients with SARS-CoV-2 and their Association with In-Hospital Mortality During the Early Phases of the Pandemic.

Introduction: Studies determined that age and associated comorbidities are associated with worse outcomes for COVID-19 patients. The aim of the present study is to examine previous electronic health records of SARS-CoV-2 patients to identify which chronic conditions are associated with in-hospital mortality in a nationally representative sample. Materials and Methods: The actual study is a cross-sectional analysis of SARS-CoV-2 infected patients who were treated in repurposed hospitals. The study includes a cohort of patients treated from 06-11-2020 to 15-03-2021 for COVID-19 associated pneumonia. To examine the presence of comorbidities, electronic health records were examined and analyzed. Results: A total of 1486 in-patients were treated in the specified period, out of which 1237 met the criteria for case. The median age of the sample was 65 years. The overall in-hospital mortality in the sample was 25.5%, while the median length of stay was 11 days. From whole sample, 16.0% of the patients did not have established diagnoses in their electronic records, while the most prevalent coexisting condition was arterial hypertension (62.7%), followed by diabetes mellitus (27.3%). The factors of age, male gender, and the number of diagnoses showed a statistically significant increase in odds ratio (OR) for in-hospital mortality. The presence of chronic kidney injury was associated with the highest increase of OR (by 3.37) for in-hospital mortality in our sample. Conclusion: The study reaffirms the findings that age, male gender, and the presence of comorbidities are associated with in-hospital mortality in COVID-19 treated and unvaccinated patients. Our study suggests that chronic kidney injury showed strongest association with the outcome, when adjusted for age, gender, and coexisting comorbidities.

Bony Cochlear Nerve Canal as a Predictor for Cochlear Nerve Status in Prelingually Deaf Children.

Objectives: The presence of a functional cochlear nerve is a key issue in the preoperative evaluation of pediatric candidates for cochlear implants. Correlations between cochlear nerve deficiency (CND) and bony abnormalities of the labyrinth or bony canal of the cochlear nerve are not yet well understood. The aim of this study was to determine whether the width of the bony cochlear canal (BCNC) can serve as a reliable predictive factor for the existence of a CND. Materials and methods: A total of 11 children with a confirmed diagnosis of prelingual, severe sensorineural hearing loss were included in this study. In all patients, indication for CI was confirmed and according to the preoperative protocol, high-resolution CT and MR were performed. Reconstructions at a distance of 0.6 mm of the axial plane and images from the HRCT of temporal bones were used for measuring the width of the BCNC. The cochlear nerves were evaluated on axial and sagittal - oblique T2 - MRI images and classified as normal, hypoplastic or aplastic. Two factors were reviewed retrospectively: the presence of inner ear anomalies and the relationship between BCNC stenosis and the existence of CND. Results: From a total of 22 temporal bones analyzed (22 ears in 11 patients), inner ear malformations were detected in 6 ears from 3 patients (27.27%). All three children had a bilateral malformation, in one it was Michel deformity and in two it was IP2 (incomplete partition 2). The BCNC diameter ranged from 0.1mm to 2.33mm with a mean value of 1.46±0.6mm. CND was recorded in 4 of 22 ears and all were associated with stenosis of the BCNC. In a total of three ears with a stenotic canal, we obtained a normal finding for the cochlear nerve on MR. Conclusion: Children with BCNC stenosis have a high incidence of CND. A narrowed BCNC on CT can be an indicator for the selection of children with sensorineural hearing loss who will need to be additionally referred for MRI in order to definitively assess the status of the cochlear nerve.

New techniques and devices for difficult airway management.

The purpose of this review is to compare old conventional techniques and devices for difficult airway management and new sophisticated techniques and devices. Recent techniques and devices are defined as the American Society of Anesthesiology (ASA) practice guidelines for the management of difficult airway, published in 1992, reviewed in 1993 and updated in 2003. According to ASA, the techniques for difficult airway management are divided into techniques for difficult intubation and techniques for difficult ventilation. Awake fiberoptic intubation is the technique of choice for difficult airway management prescribed by the World Health Organization document for patient safety in the operating theater. Conventional techniques for intubation used direct visualization. The new generation of devices does not require direct visualization of the vocal cords for endotracheal tube placement. They allow better glottis view and successful endotracheal placement of the tube with indirect laryngoscopy. New intubation devices such as video laryngoscopes facilitate endotracheal intubation by indirect visualization of glottis structures without aligning the oral, pharyngeal and laryngeal axes in patients with cervical spine abnormality. Video laryngoscopes such as V-Mac and C-Mac, Glide scope, McGrath, Airway Scope, Airtraq, Bonfils and Bullard laryngoscope are widely available at the market. Airway gadgets are lighted stylets and endotracheal tube guides. The principal conclusion of this review is that utilization of these devices can be easily learned. The technique of indirect laryngoscopy is currently used for managing difficult airway in the operating room as well as for securing the airway in daily anesthesia routine.