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.

C-reactive protein-albumin ratio and procalcitonin in predicting intensive care unit mortality in traumatic brain injury.

BACKGROUND: Prediction of intensive care unit (ICU) mortality in traumatic brain injury (TBI), which is a common cause of death in children and young adults, is important for injury management. Neuroinflammation is responsible for both primary and secondary brain injury, and C-reactive protein-albumin ratio (CAR) has allowed use of biomarkers such as procalcitonin (PCT) in predicting mortality. Here, we compared the performance of CAR and PCT in predicting ICU mortality in TBI. METHODS: Adults with TBI were enrolled in our study. The medical records of 82 isolated TBI patients were reviewed retrospectively. RESULTS: The mean patient age was 49.0 ± 22.69 years; 59 of all patients (72%) were discharged, and 23 (28%) died. There was a statistically significant difference between PCT and CAR values according to mortality (P<0.05). The area under the curve (AUC) was 0.646 with 0.071 standard error for PCT and 0.642 with 0.066 standard error for CAR. The PCT showed a similar AUC of the receiver operating characteristic to CAR. CONCLUSIONS: This study shows that CAR and PCT are usable biomarkers to predict ICU mortality in TBI. When the determined cut-off values are used to predict the course of the disease, the CAR and PCT biomarkers will provide more effective information for treatment planning and for preparation of the family for the treatment process and to manage their outcome expectations.

COVID-19 Pneumonia during Hydroxychloroquine Treatment of Rheumatoid Arthritis.

The recently emerged and novel coronavirus, severe acute respiratory distress syndrome coronavirus 2 (SARS-CoV-2), that caused the current global pandemic was detected for the first time in Turkey in March 2020. While it continues to spread rapidly worldwide, there are still many uncertainties in the prevention and treatment of new coronavirus disease. We report a case of coronavirus disease 2019 (COVID-19) pneumonia in a patient under hydroxychloroquine (HCQ) treatment for rheumatoid arthritis. A 38-year female patient developed severe respiratory distress with SARS-CoV-2 infection and was treated in Intensive Care Unit (ICU). With this report, we aim to discuss the place of HCQ in prophylaxis in the light of the literature with a case presentation of COVID-19 pneumonia under HCQ treatment. Key Words: Coronavirus, Hydroxychloroquine, Prophylaxis, Rheumatoid arthritis, COVI-19.

APACHE II or INCNS to predict mortality in traumatic brain injury: A retrospective cohort study.

BACKGROUND: Some scoring systems, such as Acute Physiology and Chronic Health Evaluation II (APACHE II), are used to predict mortality, but they are not specialized for traumatic brain injury. INCNS is a new scoring system for traumatic brain injury developed by Goa et al. INCNS score evaluates inflammation, nutrition, consciousness, neurological function and systemic condition. The present study aims to evaluate performances of Acute Physiology and Chronic Health Evaluation II (APACHE II) and INCNS to predict mortality in traumatic brain injuries. METHODS: In this study, 78 patients who were treated in anaesthesiology intensive care unit with the diagnosis of traumatic brain injury were included. Patients under the age of 18, foreigners, patients with incomplete data were excluded from this study. Medical records were examined retrospectively. APACHE II and INCNS scores in the first 24 hours were counted up. RESULTS: Of the 78 patients, 45 (57.7%) were males and 33 (42.3%) were females. The overall mortality was 34.6% (27/78). The mean APACHE II, INCNS score was 23.85±9.44 and 14.43±8.75, respectively. The area under the curve result of receiver operating characteristic curve analysis was 0.797 for the APACHE II and 0.847 for the INCNS. CONCLUSION: The INCNS scoring system had higher discriminatory power than the APACHE II in predicting the mortality of TBI in the ICU. INCNS can be considered as a usable prognostic model for Turkish people.

Pain Management for Traumatic Rib Fractures with ESP Block in ICU.

Rib fractures are common injuries in blunt chest trauma, that cause severe thoracic pain, which limits patients' ability to cough and breathe deeply, which can lead to atelectasis and pneumonia. Various treatments for pain management of rib fractures have been described such as analgesics and regional anaesthesia. The ultrasound-guided erector spinae plane block (ESP) is a novel myofascial plane block for thoracic analgesia after thoracic or abdomen surgery. It is simple to perform the block because the key landmarks of tip of transverse processes and erector spinae muscle are easily visualised on ultrasound. This also allows to treat patients more easily in intensive care unit (ICU). We present a case that used ESP for pain management related to traumatic multiple rib fractures and prevented pulmonary complications with ESP block in ICU.

Neurological outcome after cardiac arrest: a prospective study of the predictive ability of prognostic biomarkers neuron-specific enolase, glial fibrillary acidic protein, S-100B, and procalcitonin.

BACKGROUND/AIM: Factors affecting neurological outcome and the usefulness of neuron-specific enolase (NSE), S-100B, glial fibrillary acidic protein (GFAP), and procalcitonin (PCT) in predicting neurological outcomes were assessed in patients who survived at least 24 h after cardiopulmonary resuscitation (CPR). MATERIALS AND METHODS: Thirty successfully resuscitated cardiac arrest patients were included in this prospective clinical study. The initial cardiac arrest rhythm, duration of CPR, return of spontaneous circulation time, administered doses of adrenaline, base excess, blood sugar, and hemodynamic parameters were recorded. Patients with Glasgow Outcome Scale (GOS) scores of 1-3 were defined as Group I and patients with GOS scores of 4-5 were defined as Group II. Serum NSE, GFAP, S-100B, and PCT levels were compared between the two groups shortly after CPR (hour 0) and at hours 12 and 24 of the postresuscitation period. RESULTS: Serum S-100B was significantly higher (P = 0.009) in Group II immediately after CPR. Serum S-100B and NSE after CPR at hours 0, 12, and 24 were significantly lower in patients who survived to hospital discharge. Serum PCT at hours 12 and 24 and serum S-100B after CPR at 0, 12, and 24 h reached 94.7% sensitivity. Serum NSE, GFAP, S-100B, and PCT specificities were lower than 50%. CONCLUSION: In predicting neurological outcomes, serum S-100B has high sensitivity and low specificity immediately after CPR.

Effect of Anaesthesia Methods for Regaining Daily Life Activities in Cesarean Patients.

OBJECTIVE: Postpartum period is physically, socially and emotionally a difficult time for the parents and the baby to become a family. We tried to investigate how the anaesthesia method affects patients who underwent cesarean delivery, as a factor which also affects this period. METHODS: Two hundred and six parturients, who underwent elective cesarean delivery in Celal Bayar University Hafsa Sultan Hospital were recruited for our study. After demographic data and anaesthesia methods were noted, an EQ-5D health survey and Katz ADL scale were evaluated face to face 24 hours postoperatively, and by telephone on the 5th postoperative day. RESULTS: The percentage of patients who had general anaesthesia was 35.2% (n=71), while 19.8% (n=40) had epidural anaesthesia and 45% (n=91) had spinal anaesthesia. Among -these three methods, the EQ-5D health survey revealed that the outcome at postoperative 24 hours was best in epidural anaesthesia and that general anaesthesia outcome was the worst (p=0.007). The Katz ADL scale at postoperative 24. hours showed that epidural anaesthesia was better than the other methods for regaining daily life activities (p<0.05). CONCLUSION: Our study showed that epidural anaesthesia had the most effective role among the methods in regaining daily life activities after elective cesarean delivery, which was demonstrated using the EQ-5D health survey and Katz ADL scale.

Investigation of a nosocomial outbreak by alginate-producing pan-antibiotic-resistant Pseudomonas aeruginosa.

BACKGROUND: The nosocomial spread of pan-antibiotic-resistant nonfermentative bacteria is an increasing concern. This study investigated the microbiologic and epidemiologic characteristics of a hospital outbreak due to alginate-producing, pan-antibiotic-resistant Pseudomonas aeruginosa (PAR-Pa). METHODS: All patients with infection with a P. aeruginosa strain that was resistant to all Clinic Laboratory Standards Institute-suggested antimicrobial agents between November 2004 and May 2005 were included in the study. Alginate production detection and pulsed-field gel electrophoresis (PFGE) typing were done for the patient and environmental surveillance isolates. A matched case-control study was performed to identify risk factors and evaluate outcomes. RESULTS: PFGE analysis of a total of 35 PAR-Pa isolates (28 patient and 7 environmental surveillance isolates) identified a single epidemic clone as responsible for the outbreak. All epidemic isolates were alginate-producing and susceptible only to colistin. The Student t-test demonstrated that a longer stay in the intensive care unit (ICU) (6.64 days vs 1.83 days; P < .05) significantly increased the risk of PAR-Pa infection. Systemic PAR-Pa infection resulted in higher mortality (85.7% vs 27.8%; P < .05). Multivariate analysis determined that therapeutic failure (odds ratio = 24.7; 95% confidence interval = 4.144 to 147.221; P < .05) was the independent risk factor related to this high mortality. Localized PAR-Pa infections were associated with longer hospital stays (46.2% vs 14.4%; P < .05) and higher rates of surgery (85.7% vs 15.4%; P < .05) and amputation (42.8% vs 0%; P < .05). The recovery of the pathogen from staff hands and frequently handled surfaces suggests possible handborne transmission. Improved hygienic standards and application of strict contact precautions, including isolation, reduced the spread of the pathogen. CONCLUSION: This study illustrates the ability of pan-antibiotic-resistant P. aeruginosa to cause an outbreak with significant mortality and stresses the need for precautions to prevent the spread of such highly resistant strains.