Comparison of two different lung ultrasound imaging protocols in COVID-19 pneumonia.

PURPOSE: The aim of this study was to determine the effectiveness of two different lung ultrasonography (LUS) methods that can be used in the diagnosis of coronavirus disease 2019 (COVID-19) and to investigate their correlations with computed tomography (CT). METHODS: In this prospective, randomized, and single-blind study, 60 patients with COVID-19 were included. The patients were randomized to either the 12-zone LUS group (n=30) or the 14-zone LUS group (n=30). The correlation between LUS and thoracic CT scores was evaluated. As a secondary outcome measure, the characteristic features of the findings of thoracic CT and LUS were examined. RESULTS: The study was completed with a total of 59 patients. Moderate and high correlations were found between the total CT and LUS scores in the 12-zone and 14-zone study groups. There were no statistically significant differences in the lesion types detected in patients using LUS and CT (P>0.05). The left lung lower lobe CT scores were statistically significantly lower in the 14-zone study group than in the 12-zone group (P=0.019). The left lower lobe CT and LUS scores were highly correlated in the 14-zone group (P<0.001, r=0.902). CONCLUSION: The results of our study indicated that the two different LUS examination methods performed in different patients had similar findings in terms of the diagnosis and their correlations with CT results.

Evaluation of the relationship between sick building syndrome complaints among hospital employees and indoor environmental quality.

BACKGROUND: Sick building syndrome (SBS) is defined as a condition occurring in people who live or work in a modern building and who suffer from complaints such as headache, fatigue, lack of concentration, and irritation of the skin and mucous membranes. OBJECTIVES: The aim of this study is to examine the complaints associated with SBS in the employees of our hospital and evaluate the relationship between the characteristics of the work environment and the complaints of SBS. METHODS: 890 workers participated in the study. The complaints of the participants were rated and the sum of all complaints was recorded as the Total Complaint Score (TCS). The mean TCS of the participants was compared according to demographic characteristics and work environment characteristics. RESULTS: The most common complaints among the employees were fatigue (40%), and general muscle and joint pain (31.4%). There was a statistically significant difference in TCS according to the position (p < 0.001). The mean TCS was significantly higher in females [13 (0-81)] than in males [6 (0-59)] (p < 0.001). The mean TCS increased with the presence of odor, new wall paint, the presence of fungus/ mold on walls, and the presence of rotting/mold smell (p < 0.001, for all). TCS positively correlated with stress level, social relationship, noise level, comfort, cleanliness, number of employees in the same room, presence of odor, new wall paint, presence of rotting/mold, and use of chemical materials for cleaning in the room (p < 0.001, for all), and negatively correlated with room size and number of windows (p = 0.006, p < 0.001, respectively). DISCUSSION: The present study found that the female gender, a high level of education, a high level of stress, a low level of social relationships and work environment characteristics were associated with the complaints of SBS among the employees. Accordingly, we believe that hospital management should be informed in order for the managers to take precautions and make new regulations.

Do initial hematologic indices predict the severity of COVID-19 patients?

Background/aim: In this study, we aimed to evaluate the initial hematological findings analyzed on admission in confirmed COVID-19 patients who were transferred to the intensive care unit (ICU), to predict possible hematological indices. Materials and methods: Initial neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), monocyte to lymphocyte ratio (MLR), red cell distribution width to platelet ratio (RPR), mean platelet volume to platelet ratio, and lymphocyte multiplied by platelet count (LYM × PLT), of 695 patients with laboratory-confirmed COVID-19 were investigated and comparisons were made between the mild/moderate and severe groups. Results: The proportion of COVID-19 cases admitted to the ICU was 3.9%. The median age of patients admitted to the ICU was significantly higher than those who were not; [68.5 (interquartile range (IQR); 21.5] years vs. 41.0 (IQR; 15.7) years; P < 0.001. Severe cases had higher NLR (6.6 vs. 2.4; P < 0.001), and MLR (0.40 vs. 0.28; P = 0.004) and lower PLR (180.0 vs. 129.0; P < 0.001) compared to that of mild or moderate patients. Among all of the parameters, the ROC curve of NLR gave us the best ability to distinguish serious patients at an early stage (AUC = 0. 819, 95% confidence interval 0.729­0.910; P < 0.001). Conclusion: These data showed that age, initial NLR, PLR, and LYM × PLT were associated with the severity of COVID-19 disease and patients' need for the ICU. Therefore, initial hemogram parameters may be essential to predict the prognosis of COVID-19 patients.

Retrospective analysis of the apnea test and ancillary test in determining brain death. / Análise retrospectiva do teste de apneia e exames complementares na determinação de morte cerebral.

OBJECTIVE: We investigated the frequency of apnea tests, and the use of ancillary tests in the diagnosis of brain death in our hospital, as well as the reasons for not being able to perform apnea testing and the reasons for using ancillary tests. METHODS: In this retrospective study, the files of patients diagnosed with brain death between 2012 - 2018 were examined. The preferred test was determined if an ancillary test was performed in the diagnosis of brain death. The rate and frequency of use of these tests were analyzed. RESULTS: During the diagnosis of brain death, an apnea test was performed on 104 (61.5%) patients and was not or could not be performed on 65 (38.5%) patients. Ancillary tests were performed on 139 (82.8%) of the patients. The most common ancillary test was computed tomography angiography (79 patients, 46.7%). Approval for organ donation was received in the meetings with the family following the diagnosis of brain death for 55 (32.5%) of the 169 patients. CONCLUSION: We found an increase in the rate of incomplete apnea tests and concordantly, an increase in the use of ancillary tests in recent years. Ancillary tests should be performed on patients when there is difficulty in reaching a decision of brain death, but it should not be forgotten that there is no worldwide consensus on the use of ancillary tests.

OBJETIVO: Investigamos a frequência dos testes de apneia e o uso de exames complementares para o diagnóstico de morte cerebral em nosso hospital, assim como as razões para a não realização do teste de apneia e para utilização de exames complementares. MÉTODOS: Neste estudo retrospectivo, examinaram-se os arquivos de pacientes com diagnóstico de morte cerebral entre 2012 e 2018. O exame preferido foi determinado quando um exame complementar foi realizado para o diagnóstico de morte cerebral. Analisaram-se a taxa e a frequência de uso desses exames. RESULTADOS: Durante o diagnóstico de morte cerebral, o teste de apneia foi realizado em 104 (61,5%) pacientes, e não foi ou não pôde ser realizado em 65 (38,5%) deles. Realizaram-se exames complementares em 139 (82,8%) pacientes. O exame complementar mais comumente utilizado foi a angiografia por tomografia computadorizada (79 pacientes, 46,7%). Foi recebida aprovação para doação de órgãos nas reuniões com familiares após o diagnóstico de morte cerebral para 55 (32,5%) dos 169 pacientes. CONCLUSÃO: Nos anos mais recentes, identificamos aumento na taxa de testes de apneia incompletos e, concordantemente, elevação no uso de exames complementares. Os exames complementares devem ser utilizados nos pacientes quando há dificuldade para chegar à decisão do diagnóstico de morte cerebral, mas não se deve esquecer que não existe um consenso mundial a respeito do uso de exames complementares.

Análise retrospectiva do teste de apneia e exames complementares na determinação de morte cerebral / Retrospective analysis of the apnea test and ancillary test in determining brain death

RESUMO Objetivo: Investigamos a frequência dos testes de apneia e o uso de exames complementares para o diagnóstico de morte cerebral em nosso hospital, assim como as razões para a não realização do teste de apneia e para utilização de exames complementares. Métodos: Neste estudo retrospectivo, examinaram-se os arquivos de pacientes com diagnóstico de morte cerebral entre 2012 e 2018. O exame preferido foi determinado quando um exame complementar foi realizado para o diagnóstico de morte cerebral. Analisaram-se a taxa e a frequência de uso desses exames. Resultados: Durante o diagnóstico de morte cerebral, o teste de apneia foi realizado em 104 (61,5%) pacientes, e não foi ou não pôde ser realizado em 65 (38,5%) deles. Realizaram-se exames complementares em 139 (82,8%) pacientes. O exame complementar mais comumente utilizado foi a angiografia por tomografia computadorizada (79 pacientes, 46,7%). Foi recebida aprovação para doação de órgãos nas reuniões com familiares após o diagnóstico de morte cerebral para 55 (32,5%) dos 169 pacientes. Conclusão: Nos anos mais recentes, identificamos aumento na taxa de testes de apneia incompletos e, concordantemente, elevação no uso de exames complementares. Os exames complementares devem ser utilizados nos pacientes quando há dificuldade para chegar à decisão do diagnóstico de morte cerebral, mas não se deve esquecer que não existe um consenso mundial a respeito do uso de exames complementares.

Abstract Objective: We investigated the frequency of apnea tests, and the use of ancillary tests in the diagnosis of brain death in our hospital, as well as the reasons for not being able to perform apnea testing and the reasons for using ancillary tests. Methods: In this retrospective study, the files of patients diagnosed with brain death between 2012 - 2018 were examined. The preferred test was determined if an ancillary test was performed in the diagnosis of brain death. The rate and frequency of use of these tests were analyzed. Results: During the diagnosis of brain death, an apnea test was performed on 104 (61.5%) patients and was not or could not be performed on 65 (38.5%) patients. Ancillary tests were performed on 139 (82.8%) of the patients. The most common ancillary test was computed tomography angiography (79 patients, 46.7%). Approval for organ donation was received in the meetings with the family following the diagnosis of brain death for 55 (32.5%) of the 169 patients. Conclusion: We found an increase in the rate of incomplete apnea tests and concordantly, an increase in the use of ancillary tests in recent years. Ancillary tests should be performed on patients when there is difficulty in reaching a decision of brain death, but it should not be forgotten that there is no worldwide consensus on the use of ancillary tests.

Prevalence of pressure ulcers in hospitalized adult patients in Bursa, Turkey: A multicentre, point prevalence study.

RATIONALE, AIMS, AND OBJECTIVES: Pressure ulcers (PUs), which are preventable complications, increase the cost of health care and the risk of prolonged hospital stay, as well as morbidity and mortality. In this study, we aimed to describe the prevalence, clinical features, and risk factors for PUs among hospitalized patients. METHOD: This study was cross-sectional and conducted over a single day in all the care units. Data were recorded on a patient observation form that included demographic data, diagnosis of admission to the hospital or intensive care unit (ICU), comorbidity and chronic diseases, location, stage of PU, and Braden Scale score. Acute physiology and chronic health evaluation (APACHE) II score, Glasgow coma score (GCS), PaO2 /FiO2 ratio, and albumin level were recorded for ICU patients. RESULTS: A total of 1548 adult patients participated in the study. Of these patients, 177 (11.43%) had PU. The patients with PU had more advanced age, lower body mass index (BMI), and longer duration of hospital and ICU stay (for all P = .001). Evaluation of PU in the first 24 hours after hospital admission and the last PU evaluation time also showed a significant effect (both P = .001). Braden Scale score less than or equal to 13 in the first evaluation after hospital admission increased the risk of PU. Albumin was 2.78 ± 0.57 gm/dL in ICU patients, and albumin level was significantly lower in patients with PU (P = .001). PUs were located mainly in the sacrum (47.59%) and were classified as stage II (42.76%) for all patients. CONCLUSIONS: The prevalence of PU is related to the age and severity of patient clinical status, as predicted by the Braden Scale score and APACHE II score, and length of hospital and ICU stay. Low albumin level is also related to development of PUs in ICU patients.

A Comparision of the Effect of Sugammadex on the Recovery Period and Postoperative Residual Block in Young Elderly and Middle-Aged Elderly Patients.

BACKGROUND: The importance of the characteristics of anesthesia and postoperative residual curarization (PORC) in the elderly population should be a growing concern in this century. AIMS: To investigate the effect of sugammadex on the duration of the recovery from neuromuscular blocking agents and postoperative residual curarization in the young elderly and middle-aged elderly patients who underwent elective laparoscopic cholecystectomy, followed by a train of four (TOF) watch monitorization. STUDY DESIGN: Prospective clinical trial study. METHODS: Sixty patients over the age of 65 with American Society of Anesthesiologists I-III were divided into two groups according to their age (65-74 years old and ≥75 years old). Patients received sugammadex (2.0 mg/kg iv) at the reappearance of the second twitch of the TOF as an agent for reversal of neuromuscular blockage at the end of surgery. Patients were extubated at the time of TOF ≥0.9. The patients' TOF responses were evaluated with regards to PORC in at the 5th minute and were followed up for one hour in the recovery room. Reintubation was applied for those patients who developed PORC and had peripheric oxygen saturation <90% despite being given 6 L oxygen per min with a face mask. RESULTS: The onset time of neuromuscular blocking agent and time from T2 to achieve TOF ratio 90% (the duration of sugammadex effect) or over were found to be longer in the middle-aged elderly group than in the young elderly group. A statistically significant relationship was found between age and the duration of TOF ratio to reach 0.9 in the same direction. The PORC incidence and rate of reintubation were found to be 1.7% in all patients. CONCLUSION: In our opinion, it is necessary to remember that the duration of sugammadex effect on the recovery period is prolonged for patients who are aged ≥75 years compared to patients aged between 65-74 years. (ClinicalTrials.gov Identifier: ACTRN12615000758505).