The Impact of CoronaVac Vaccination on 28-day Mortality Rate of Critically Ill Patients with COVID-19 in Türkiye.

Background: Vaccines against coronavirus disease-19 (COVID-19) have been effective in preventing symptomatic diseases, hospitalizations, and intensive care unit (ICU) admissions. However, data regarding the effectiveness of COVID-19 vaccines in reducing mortality among critically ill patients with COVID-19 remains unclear. Aims: To determine the vaccination status and investigate the impact of the COVID-19 vaccine on the 28-day mortality in critically ill patients with COVID-19. Study Design: Multicenter prospective observational clinical study. Methods: This study was conducted in 60 hospitals with ICUs managing critically ill patients with COVID-19. Patients aged ≥ 18 years with confirmed COVID-19 who were admitted to the ICU were included. The present study had two phases. The first phase was designed as a one-day point prevalence study, and demographic and clinical findings were evaluated. In the second phase, the 28-day mortality was evaluated. Results: As of August 11, 2021, 921 patients were enrolled in the study. The mean age of the patients was 65.42 ± 16.74 years, and 48.6% (n = 448) were female. Among the critically ill patients with COVID-19, 52.6% (n = 484) were unvaccinated, 7.7% (n = 71) were incompletely vaccinated, and 39.8% (n = 366) were fully vaccinated. A subgroup analysis of 817 patients who were unvaccinated (n = 484) or who had received two doses of the CoronaVac vaccine (n = 333) was performed. The 28-day mortality rate was 56.8% (n = 275) and 57.4% (n = 191) in the unvaccinated and two-dose CoronaVac groups, respectively. The 28-day mortality was associated with age, hypertension, the number of comorbidities, type of respiratory support, and APACHE II and sequential organ failure assessment scores (p < 0.05). The odds ratio for the 28-day mortality among those who had received two doses of CoronaVac was 0.591 (95% confidence interval: 0.413-0.848) (p = 0.004). Conclusion: Vaccination with at least two doses of CoronaVac within six months significantly decreased mortality in vaccinated patients than in unvaccinated patients.

The Preseptic Period and Inflammatory Markers in the Prediction of the Course of Sepsis.

BACKGROUND The aim of this study was to find a simple and easily accessible scoring system that could predict the development of sepsis in the preseptic period. MATERIAL AND METHODS The study included 161 patients with a basal sequential organ failure assessment (SOFA) value of 2 or more. The sepsis group (n=83) comprised patients with infection reported in culture results; the control group (n=78) comprised patients not showing evidence of infection in blood, urine, and phlegm cultures; samples were taken on three consecutive days. RESULTS The patients in both groups were divided into subgroups of non-survivor and survivor patients. The preseptic and septic SOFA score, neutrophil lymphocyte ratio (NLR), and procalcitonin (PRC) and lactate (Lac) values were determined to be statistically significantly higher in the sepsis group than in the control group. When the values related to sepsis were examined, a strong relationship was determined between sepsis and SOFA score, PRC values, and Lac values in the preseptic period and a weak relationship with NLR. In the model formed using multiple regression analysis with defined cutoff values for the preseptic and the septic periods, we found that in the septic period, a diagnosis of sepsis could be made with 83.8% accuracy. The diagnostic value of the same parameters evaluated in the preseptic period was 77.9%. CONCLUSIONS The diagnostic value of the combination of Lac, PRC, SOFA, and NLR were found to be similar in the preseptic period as the sepsis period; thus these combined values could safely be used for the early diagnosis of sepsis.

Vasculitis and neurobrucellosis: Evaluation of nine cases using radiologic findings.

Background: Brucellosis is an important multisystemic disease with many different clinical symptoms, and its early diagnosis and treatment are possible. Neurobrucellosis (NB) is a rare but serious finding of brucellosis. Brucella can be seen as meningitis and encephalopathy, and it can cause cranial nerve pathologies, vascular syndromes, myopathy, spinal diseases, and psychiatric disorders. In NB, vascular syndromes secondary to inflammation are rarely seen. Here, we present nine young patients with vascular and nonspecific neuropsychiatric findings who had NB as the etiology of stroke. Methods: Nine patients who were admitted to our Neurology Clinic between 2012 and 2017 for various reasons in whom brucellosis was found in the etiology were retrospectively studied. The patients' symptoms, physical examination, laboratory and radiographic findings, treatments, and treatment responses are discussed. Results: Of the nine patients who presented to our clinic in the 4-year period, five were female. The average age was 49 years. Five patients had small vessel vasculitis, three had great vessel vasculitis, and one had meningoencephalitis and pons abscess. Two patients had granuloma, and one had an aneurysm. Conclusions: We aimed to present our cases due to the fact that this disease should be kept in mind in the differential diagnosis of patients with stroke and similar neuropsychiatric findings.

Effects of dexmedetomidine and propofol on sedation in patients after coronary artery bypass graft surgery in a fast-track recovery room setting.

PURPOSE: We aim to compare the effects of propofol and dexmedetomidine infusions on extubation times, hemodynamic and respiratory functions, complication rates and patient satisfaction scores in patients undergoing coronary artery bypass graft (CABG) surgery using a fast-track anesthesia regimen for early extubation. METHODS: We enrolled 64 patients who underwent CABG surgery. Dexmedetomidine (min 0.2 µg/kg/h-max 1.0 µg/kg/h) and propofol (min 1.0 mg/kg/h-max 3.0 mg/kg/h) infusion doses were titrated to give bispectral index values between 60 and 90 and a Ramsay sedation score (RSS) between 3 and 4. Postoperative extubation times, patient satisfaction and postoperative adverse events were recorded. RESULTS: The mean times to extubation were 265.94 ± 43.1 min for the dexmedetomidine group and 322.52 ± 39.2 min for the propofol group (P < 0.001). In all recordings, RSS median values for the propofol group were significantly lower than the dexmedetomidine group (P < 0.05). There were no differences in the incidence of postoperative adverse events between the dexmedetomidine and propofol groups. There was a statistically significant difference between patient satisfaction median values of the two groups-7 (5-9) and 9 (7-10) (min-max) for the propofol and dexmedetomidine groups, respectively (P < 0.001). CONCLUSION: Our results show that dexmedetomidine can easily be preferred over propofol in fast-track cardiac anesthesia due to its significant advantages of shorter extubation time and higher postoperative patient satisfaction scores.