Anxiety and depression levels of healthcare workers during Covid-19 pandemic.

Background: Coronavirus disease 2019 (covid-19), which causes a pandemic in the world, has started to appear in turkey since march 2020. Healthcare workers are at the top of the groups most at risk for covid-19 infection, which can have a negative impact on psychological state. Objectives: It was aimed to evaluate anxiety and depression levels among healthcare workers. Methods: this cross-sectional study performed via an online survey in april 2020. Participants answered questions about sociodemographic features, personal views and experiences about covid-19 and the hospital anxiety and depression scale (hads). Results: A total of 300 healthcare workers,193 men and 107 women, participated in the survey. According to hads, 44.6% of participants scored above anxiety and 68.2% scored above depression cut-off points. Being younger than 50 and taking care of covid-19 patients in hospitals were independently associated with anxiety risk. Female gender, young age (less than 50) and having comorbidity were independent risk factors for depression. Conclusion: Healthcare workers were at high risk of anxiety and depression during covid-19 outbreak. For this reason, psychological support should be given, especially to the group with high risk.

The role of volumetric method in the assessment of chemotherapy response and predicting survival in malignant pleural mesothelioma.

BACKGROUND: Malignant pleural mesothelioma (MPM) is a pleural tumor with high mortality rate and short-term survival expectancy after diagnosis. Assessment of the response to chemotherapy, which is the first choice in treatment of MPM, is important for the transition to alternative chemotherapy protocols and immunotherapy. There is no clarity in the response to chemotherapy treatment. OBJECTIVE: Our study aims to compare the assessment of chemotherapy response using the Modified Response Evaluation Criteria in Solid Tumors (mRECIST) criteria and volumetric measurements and to correlate with median survival. MATERIALS AND METHODS: Thirty-two patients (16 females and 16 males) were included in the study, and their ages ranged from 28 to 78 years. Chemotherapy response was determined by both mRECIST and volumetric approach. Tumor volume was measured by linear interpolation and semi-automatic segmentation. Log-rank multiple cutoff analysis was used to determine appropriate cutoff values of volumetric response criteria. RESULTS: According to both mRECIST and volumetric approach, median survival times in partial response, stable disease, and progressive disease groups were 24, 15, and 9 months, respectively. The survival times of the three groups were different (logrank: 17.76; P < 0.001) by mRECIST. The survival of the progressive disease group was shorter than that of the other groups (logrank: 18.91; P < 0.001) by volumetric approach. CONCLUSIONS: In the assessment of chemotherapy response, even though classifications obtained according to the mRECIST criteria and volumetric measurements are statistically compatible, we think that the measurement of the volumetric values will increase the standardization. In our study, threshold values for volumetric measurements were determined; however, these values should be supported by large-scale multicenter studies.

The efficacy of non-invasive positive pressure ventilation in ARDS: a controlled cohort study.

Few studies have investigated non-invasive positive pressure ventilation (NPPV) in acute respiratory distress syndrome (ARDS). The aim of this controlled cohort study was to determine the efficacy of NPPV in ARDS. Two hundred and eighty- seven patients were monitored in the respiratory intensive care unit over two years. Twenty-two subjects met the American-European consensus criteria for ARDS and were included in the study. Patients were prospectively allocated into standard therapy group and NPPV group. Indications for invasive mechanical ventilation were determined before study commencement. Invasive ventilation was applied to those needing intubation. Those in the NPPV group showing no indications for urgent intubation received NPPV in addition to standard medical therapy. Subjects with indications for intubation were intubated. Primary outcome was intubation rate; secondary outcome was hospital mortality. Seventeen patients were males, 18 (90%) patients were treated for pulmonary ARDS. Mean age was 45.2 years; mean PaO(2)/FiO(2) was 106.6. The need for intubation emerged for eight patients in the standard therapy group. Seven patients in the NPPV group received NPPV, and three patients in this group needed immediate intubation. NPPV was successful in 4 (57%) patients and the other three required intubation for high PEEP or NPPV intolerance. Mean duration of NPPV was 58.3 hours. There was no difference in Acute Physiology Assessment and Chronic Health Evaluation (APACHE) II scores and initial PaO(2)/FiO(2) values between successful and unsuccessful NPPV groups; but the difference between PaO(2)/FiO(2) ratios at 24 hours between these groups was statistically significant (193.0 and 93.3, respectively; p= 0.003). While using NPPV in ARDS patients, if improvement is not seen in the first day, invasive mechanical ventilation should be implemented immediately.