Vaccination status of COVID-19 patients followed up in the ICU in a country with heterologous vaccination policy: A multicenter national study in Turkey.

OBJECTIVE: Vaccination against severe acute respiratory syndrome coronavirus-2 (SARS-2) prevents the development of serious diseases has been shown in many studies. However, the effect of vaccination on outcomes in COVID-19 patients requiring intensive care is not clear. METHODS: This is a retrospective multicenter study conducted in 17 intensive care unit (ICU) in Turkey between January 1, 2021, and December 31, 2021. Patients aged 18 years and older who were diagnosed with COVID-19 and followed in ICU were included in the study. Patients who have never been vaccinated and patients who have been vaccinated with a single dose were considered unvaccinated. Logistic regression models were fit for the two outcomes (28-day mortality and in-hospital mortality). RESULTS: A total of 2968 patients were included final analysis. The most of patients followed in the ICU during the study period were unvaccinated (58.5%). Vaccinated patients were older, had higher Charlson comorbidity index (CCI), and had higher APACHE-2 scores than unvaccinated patients. Risk for 28-day mortality and in-hospital mortality was similar in across the year both vaccinated and unvaccinated patients. However, risk for in-hospital mortality and 28-day mortality was higher in the unvaccinated patients in quarter 4 adjusted for gender and CCI (OR: 1.45, 95% CI: 1.06-1.99 and OR: 1.42, 95% CI: 1.03-1.96, respectively) compared to the vaccinated group. CONCLUSION: Despite effective vaccination, fully vaccinated patients may be admitted to ICU because of disease severity. Unvaccinated patients were younger and had fewer comorbid conditions. Unvaccinated patients have an increased risk of 28-day mortality when adjusted for gender and CCI.

Evaluation of skeletal muscle mass as a predictor of prognosis in patients treated in hospital for COVID-19 infection.

SUBJECTIVE: Skeletal muscle indexes are known to be one of the important prognostic indicators in many clinical situations. This study aims to evaluate the effects of laboratory values and muscle mass measures such as skeletal muscle area (SMA), skeletal muscle index (SMI), skeletal muscle density (SMD) and skeletal muscle gauge (SMG) obtained from the 12th thoracic vertebra (T12) level of patients hospitalized for COVID-19 infection on prognosis. METHODS: The patients' age, comorbidity index (CCI) scores, gender, anthropometric criteria such as height, weight, and BMI, laboratory values, development of NIMV and IC need during follow-up, length of hospital stay, and hospital mortality were retrospectively screened. The relationship between clinical and laboratory variables, SMA, SMI, SMD, and SMG values, and patient outcomes such as the need for non-invasive mechanical ventilation (NIMV), need for intensive care, and mortality was investigated using multivariate logistic regression analysis. RESULTS: It was shown in multilinear regression analysis that T12SMD (ß=-0.254; p=0.036), albumin (ß=-0.465; p=0.005), and procalcitonin values (ß=-0.292; p=0.026) were independent risk factors on mortality for intensive care in patients hospitalized due to COVID-19 infection. T12SMD has been shown to be significantly associated with various negative outcomes such as mortality, need for NIMV, and need for intensive care independently of body mass index (BMI) in our study (Tab. 5, Fig. 2, Ref. 25).

Treatment-refractory paraneoplastic opsoclonus-myoclonus syndrome in a patient with small-cell carcinoma of the lung.

Opsoclonus-myoclonus syndrome is a rare disease and traditionally described as "dancing eyes, dancing feet syndrome." It is characterized by opsoclonus (oscillations of the eyes in either horizontally or vertically) and myoclonus (spontaneous jerky movements of the limbs and trunk). There are numerous etiological factors defined such as paraneoplastic, para-infectious, toxic-metabolic, and idiopathic causes. The experience of opsoclonus-myoclonus syndrome in adults is very limited. Here, we present a case of treatment-refractory paraneoplastic opsoclonus-myoclonus syndrome associated with small-cell carcinoma of the lung.

Rectus abdominis and rectus femoris muscle thickness in determining nutritional risk in critically ill patients: a prospective cohort study in Turkey.

OBJECTIVES: Malnutrition is a clinical condition that is frequently seen in critically ill patients in the intensive care unit (ICU). Although there are many scoring systems and tools used to determine nutritional risk, those that can be used in critically ill patients in the ICU are very few. The scoring systems used are insufficient to identify ICU patients with malnutrition or at risk.Malnutrition is generally presented with a decrease in skeletal muscle mass and muscle strength. Therefore, in many recent studies, attention has been drawn to the relationship between nutritional status and loss of muscle mass. DESIGN: A cohort study. SETTING: Forty-five patients hospitalised in an anaesthesia ICU in Turkey were included in the study. PARTICIPANTS: Patients aged 18 years and older. INTERVENTIONS: Demographic data of patients included in the study, and Nutritional Risk Screening 2002 (NRS-2002) and Modified Nutrition Risk in Critically ill (mNUTRIC) scores in the first 24 hours of ICU admission were noted. Rectus abdominis muscle (RAM) and rectus femoris muscle (RFM) thicknesses were measured by the same person (intensive care specialist) with ultrasonography (USG). OUTCOME MEASURES: Finding a quantitative and practical evaluation method by determining the correlation of measurement of RAM and RFM thickness with USG with NRS-2002 and mNUTRIC score, which are scoring systems used to assess nutritional risk. RESULTS: The performance of RAM and RFM thickness in determining nutritional status was evaluated by receiver operating characteristic (ROC) analysis. Area under the ROC curves were calculated as >0.7 for RFM and RAM measurements (p<0.05). Specificity and sensitivity percentages of RAM were found to be higher than RFM in determining nutritional status. CONCLUSION: This study showed that RAM and RFM thickness measured by USG can be a reliable and easily applicable quantitative method that can be used to determine nutritional risk in the ICU.