The role of intensive care nurses in cellular treatments during the COVID-19 pandemic.

BACKGROUND: Today, the use of cellular therapies as an effective treatment in the field of health is increasing. In the COVID-19 pandemic or similar situations, cellular therapies may be sometimes life-saving. The COVID-19 pandemic has shown us that the training of intensive care nurses in special cases, such as cellular therapies, is insufficient. AIM: The study aimed to determine the duties, responsibilities and training of intensive care nurses on mesenchymal stem cells (MSCs) transplantation to critically ill patients during the COVID-19 pandemic. STUDY DESIGN: This descriptive and retrospective study was conducted on 107 critically ill patients diagnosed with COVID-19 infection and followed up in the intensive care unit (ICU) between April 2020 and April 2022. Each patient was transplanted MSCs by intravenous infusion three times. Before starting cellular therapy applications, intensive care nurses were selected to work on this treatment modality. Each nurse was given theoretical and practical training by experienced instructors. RESULTS: Intensive care nurses trained for MSCs transplants took part in the pre-application, preparation, application and post-application period. MSCs were checked by the ICU nurses in the pre-application period. Patients' vital signs, existing catheters, consciousness status and parameters were checked by nurses in the preparation and application period. No side effects and complications were observed in patients during MSCs transplantation and within the first 24 h. Patients' late complications and mortality were recorded by nurses during the post-application periods. CONCLUSIONS: We recommend that nurses working especially in Level 3 ICUs receive training and certification in cellular therapies, especially in hospitals where advanced/cellular treatments are applied. RELEVANCE TO CLINICAL PRACTICE: Intensive care nurses are actively involved in every phase of the application of MSCs. Especially before such special practices, which came to the fore with the COVID-19 pandemic, training should be organized for intensive care nurses.

Clinical evaluation of resin infiltration treatment masking effect on hypomineralised enamel surfaces.

BACKGROUND: Resin infiltration is a micro-invasive treatment for molar incisor hypomineralisation (MIH). In this study it was aimed to evaluate the masking effect of resin infiltration treatment (ICON) on hypomineralised enamel surface of permanent anterior teeth by using laser fluorescence, spectrophotometer, and cross-polarisation photography. METHODS: A total of 116 permanent central incisors in 37 patients were included in the study. The resin infiltration treatment (Icon®) was applied to the teeth with MIH; the healthy teeth received no treatment (control). Hypomineralised enamel lesions were evaluated by ICDAS II criteria. DIAGNOdent Pen was used to assess the lesions and healthy enamel surface quantitatively. Colour changes in enamel lesions were evaluated by using a spectrophotometer (VITA EasyShare). Each enamel lesion was imaged using a cross-polarization technique before and after treatment. All photos were assessed using Image J to evaluate the changes in lesion size. Enamel lesions were evaluated before; immediately after; 1; 3; and 6 months after treatment. Statistical significance was set as p < 0.05. RESULTS: After the resin infiltration, significant decreases were found in the mean DIAGNOdent values for the treatment group (p < 0.05). The colour differences before and after treatment significantly differed in all follow-ups (p < 0.05). In the treatment group, lesion areas decreased significantly after treatment (p < 0.05). CONCLUSIONS: The resin infiltration treatment has a masking effect on MIH lesions without cavities, with stable outcomes after six months. The cross-polarization photography technique may be use to evaluate the lesion size instead of photography with flash. TRIAL REGISTRATION: NCT04685889 (registered 28 December 2020).

What do we Know about Bullying in Syrian Adolescent Refugees? A Cross Sectional Study from Turkey : (Bullying in Syrian Adolescent Refugees).

The aim of this study was to assess the bullying status of Syrian adolescent refugees in Turkey and identify factors that contribute to bullying. The adolescents aged between 12 and 16 years and who live in Kilis as a Syrian refugee assessed between the dates 01.01.2019-01.01.2020. Currently, 119 children and adolescents were enrolled in the study. Kiddie-Schedule for Affective Disorders and Schizophrenia (present and life time version - K-SADS-PL) was applied by a specialist of child and adolescent psychiatry. The Sociodemographic Data Form, The Strengths and Difficulties Questionnaire (SDQ) and Olweus Bully/Victim Questionnaire (OBVQ) were used for assesment of children and adolescents. Of the study sample, 31 adolescents (27.1%) were diagnosed with at least one psychiatric disorder. The most prevalent psychiatric disorder was Other Specified Trauma and Stressor Related disorder (13.4%) and Post- traumatic stres disorder (6.7%). The prevalence of bullying and victimization was found as 58.9%. The boys group was significantly more likely to be bully and both victim and bully (p = 0.04, p = 0.001* respectively) compared to the girls group. Our results demonstrate that besides the past experiences related to war and immigration, the adolescent refugees experienced bullying consequences of being a refugee in Turkey.

The effect of mesenchymal stem cells administration on DNA repair gene expressions in critically ill COVID-19 patients: prospective controlled study.

When the studies are evaluated, immunomodulatory effect of MSCs, administration in critically ill patients, obstacle situations in use and side effects, pulmonary fibrosis prevention, which stem cells and their products, regeneration effect, administration route, and dosage are listed under the main heading like. The effect of MSC administration on DNA repair genes in COVID-19 infection is unknown. Our aim is to determine the effect of mesenchymal stem cells (MSCs) therapy applied in critically ill patients with coronavirus infection on DNA repair pathways and genes associated with those pathways. Patients (n = 30) divided into two equal groups. Group-1: Patients in a critically ill condition, Group-2: Patients in critically ill condition and transplanted MSCs. The mechanism was investigated in eleven genes of five different pathways; Base excision repair: PARP1, Nucleotide excision repair (NER): RAD23B and ERCC1, Homologous recombinational repair (HR): ATM, RAD51, RAD52 and WRN, Mismatch repair (MMR): MLH1, MSH2, and MSH6, Direct reversal repair pathway: MGMT. It was found that MSCs application had a significant effect on 6 genes located in 3 different DNA damage response pathways. These are NER pathway genes; RAD23 and ERCC1, HR pathway genes; ATM and RAD51, MMR pathway genes; MSH2 and MSH6 (p < 0.05). Two main points were shown. First, as a result of cellular damage in critical patients with COVID-19, DNA damage occurs and then DNA repair pathways and genes are activated in reaction to this situation. Second, administration of MSC to patients with COVID-19 infection plays a positive role by increasing the expression of DNA repair genes located in DNA damage pathways.

The effect of therapeutic plasma exchange therapy on veno-venous ECMO weaning success in severe COVID-19 ARDS patients.

INTRODUCTION: Primarily, this study aimed to investigate the effect of TPE (therapeutic plasma exchange) treatment on successful ECMO weaning in severe COVID-19 ARDS patients treated with V-V ECMO. METHODS: The study was applied retrospectively on patients over the age of 18 who were hospitalized in the ICU between January 1, 2020 and March 1, 2022. RESULTS: The study was performed on 33 patients, 36.3% (n: 12) of whom received TPE treatment. The rate of successful ECMO weaning was statistically higher in the TPE treatment group (without TPE: 14.3% [n: 3], with TPE: 50% [n: 6], p = 0.044). The 1-month mortality was also statistically lower in the TPE treatment group (p = 0.044). In the logistic analysis, It was found that the risk of unsuccessful ECMO weaning increased 6 times in those who did not receive TPE treatment (OR; 6.0, 95% CI; 1.134-31.735, p = 0.035). CONCLUSION: TPE treatment may increase the success rate of V-V ECMO weaning in severe COVID-19 ARDS patients treated with V-V ECMO.

Evaluation of Patients with COVID-19 Followed Up in Intensive Care Units in the Second Year of the Pandemic: A Multicenter Point Prevalence Study.

OBJECTIVE: A 1-day point prevalence study was planned to obtain country data by determining the clinical characteristics, follow-up and treatment methods of coronavirus disease 2019 (COVID-19) cases that required intensive care unit (ICU) treatment in the second year of the pandemic. MATERIAL AND METHODS: All patients who were hospitalized in the ICUs due to COVID-19 between March 11, 2022, 08.00 am, and March 12, 2022, 08.00 am, were included in the study. Demographic characteristics, intensive care and laboratory data, radiological characteristics, and follow-up results of the patients were recorded. RESULTS: A total of 811 patients from 59 centers were included in the study, 59% of the cases were male, and the mean age was 74 ± 14 years. At least one comorbid disease was present in 94% of the cases, and hypertension was the most common. When ICU weight scores were examined, Acute Physiology and Chronic Health Evaluation-II: 19 (15-27) and Sequential Organ Failure Assessment: 7 (4-10) were seen. Sepsis was present in 37% (n = 298) of cases. PaO2/FiO2 ratios of the patients were 190 the highest and 150 the lowest and 51% of the cases were followed via invasive mechanical ventilation. On the study day, 73% bilateral involvement was seen on chest x-ray, and ground-glass opacities (52%) were the most common on chest tomography. There was growth in culture in 40% (n = 318) of the cases, and the most common growth was in the tracheal aspirate (42%). CONCLUSION: The clinical course of COVID-19 is variable, and ICU follow-up was required due to advanced age, comorbidity, presence of respiratory symptoms, and widespread radiological involvement. The need for respiratory support and the presence of secondary infection are important issues to be considered in the follow-up. Despite the end of the second year of the pandemic and vaccination, the high severity of the disease as well as the need for follow-up in ICUs has shown that COVID-19 is an important health problem.

What Should Be Design, Organization and Role of Pandemic Hospitals in COVID-19 Infection?

INTRODUCTION: The aim of this study was to evaluate the physical structure, design, management, and organization of two emergency hospitals built in Istanbul within 45 days in the COVID-19 pandemic and the role played by these hospitals during the pandemic. A further aim was to determine the advantages and disadvantages of the emergency hospitals by comparing them with similar organizational models in other countries. METHODS: The pandemic hospitals established for the COVID-19 pandemic in Istanbul were investigated in a multi-faceted manner. The parameters investigated were physical structure, bed, and intensive care capacity, mechanics and infrastructure, medical equipment, personnel, organizational structures and management, and the medical services provided by both emergency hospitals during the outbreak. RESULTS: The pandemic hospitals were built on an open area of 125.000 m2 as a hospital building of 75.150 m2. Each hospital has a total bed capacity of 1008, with 576 being clinical and 432 being intensive care beds. The management of the pandemic hospitals is connected to two different hospital management structures, which are experienced in disasters and have all kinds of training, research clinics and academic personnel in this regard. CONCLUSION: The healthcare services provided by both the pandemic hospitals fulfilled the purpose of those hospitals during the pandemic. As it is most likely that the world will face other serious disasters and epidemics in the future, the construction of multi-purpose and permanent emergency hospitals instead of emergency temporary hospitals would be more advantageous in terms of economy, medical service, and environment.

The Effect of Host miRNAs on Prognosis in COVID-19: miRNA-155 May Promote Severity via Targeting Suppressor of Cytokine Signaling 1 (SOCS1) Gene.

The epigenetic features contribute to variations in host susceptibility to SARS-CoV-2 infection and severity of symptoms. This study aimed to evaluate the relationship between the relative expression of microRNAs (miRNAs) and the severity of the disease in COVID-19 patients. The miRNA profiles were monitored during the different stages of the disease course using reverse transcription-quantitative polymerase chain reaction (RT-qPCR). The expression levels of the selected 11 miRNAs were measured in the blood samples collected from 73 patients (moderate, n = 37; severe, n = 25; critically ill, n = 11, a total of 219 longitudinal samples) on hospitalization day and days 7 and 21. Expression changes were expressed as "fold change" compared to healthy controls (n = 10). Our study found that several miRNAs differed according to disease severity, with the miR-155-5p the most strongly upregulated (p = 0.0001). A statistically significant negative correlation was observed between the expression of miR-155-5p and its target gene, the suppressor of cytokine signaling 1 (SOCS1). The relative expression of miR-155-5p was significantly increased and SOCS1 was significantly decreased with the disease progression (r = -0.805 p = 0.0001, r = -0.940 p = 0.0001, r = -0.933 p = 0.0001 for admission, day 7, and day 21, respectively). The overexpression of miR-155-5p has significantly increased inflammatory cytokine production and promoted COVID-19 progression. We speculated that microRNA-155 facilitates immune inflammation via targeting SOCS1, thus establishing its association with disease prognosis.

BDNF gene expression association with suicide and psychiatric disorders in children and adolescents: (Relationship between BDNF gene expression and suicide).

OBJECTIVE: In the current study, it was aimed to investigate the relationship between BDNF gene expression and childhood suicide attempt, childhood traumatic experiences, and problem-solving skills in children and adolescents. METHODS: The suicide group consisted of 100 children and adolescents aged 11-18 years who were referred to our outpatient department due to suicide attempt. For further comparisons, 100 children and adolescents who have no any psychiatric diagnosis were referred to our same outpatient department were selected. A sociodemographic data form, the Schedule for Affective Disorders and Schizophrenia for School-Age Children- Present and Lifetime version (K-SADS-PL), the Suicide Intent Scale (SIS), Problem Solving Inventory (PSI), and the Childhood Trauma Questionnaire (CTQ) were used for both groups. Total RNA was isolated from whole blood samples and BDNF gene expression levels were measured using quantitative real time-polymerase chain reaction (QRT-PCR). RESULTS: The total and subscale scores of the PSI and CTQ were found to be significantly higher in the suicide group than in the control group. There was no significant difference between the groups in terms of BDNF gene expression levels. However, gene expression of BDNF was found significantly increased in patients who have any psychiatric disorder compared with the others. CONCLUSION: Our results indicate that BDNF gene expression could be more associated with psychiatric disorders rather than suicide attempt in children and adolescents.

Assessment of Psychopathology and Quality of Life in Children and Adolescents With Migraine.

AIM: The aims of this study were to investigate comorbid psychiatric disorders and to identify anxiety and depression levels and quality of life in children and adolescents with migraine; and to assess their relationship with migraine. METHOD: 35 patients aged 9-16 years were followed in our neurology clinic and their parents were included into the study. 35 age- and sex-matched patients were employed as the control group. In the subjects included, psychiatric disorders were assessed by using the Schedule for Affective Disorders and Schizophrenia for School Age Children-Present and Lifetime Version. All children and adolescents were assessed by using the Children's Depression Inventory, the State-Trait Anxiety Inventory and the Pediatric Quality of Life Inventory. In addition, the Pediatric Migraine Disability Assessment Tool and visual analog scale were used to identify the degree of disability and pain severity in patients with migraine. FINDINGS: In the psychiatric assessment of children and adolescents with migraine, it was found that a psychiatric diagnosis was made in 40% of patients; and depression scale scores were significantly higher than those of controls. Quality of life was found to be poorer in patients with migraine compared to controls. It was found that quality of life was negatively correlated with pain severity and degree of disability; while it was positively correlated with depression scores. DISCUSSION: In children and adolescents with migraine, treatment of psychiatric disorders in addition to migraine therapy can facilitate migraine management and may decrease the need for prophylactic therapy.