Biruni Index as a Novel Diagnostic Tool for the Early Prediction of Mortality in Critical Patients With COVID-19: A Cohort Study.

BACKGROUND: The aim of this study was to find out the potential risk factors associated with mortality in severe coronavirus disease 2019 (COVID-19) patients hospitalized due to viral bronchopneumonia, and to establish a novel COVID-19 mortality index for daily use. METHODS: The study included 431 quantitative real-time polymerase chain reaction (qRT-PCR)-confirmed COVID-19-positive patients admitted to the intensive care unit in a tertiary care hospital. Patients were divided into training and validation cohorts at random (n= 285 and n= 130, respectively). Biruni Index was developed by multivariate logistic regression analysis for predicting COVID-19-related mortality. RESULTS: In univariate logistic regression analysis, age, systolic and diastolic blood pressures, respiratory and pulse rates per minute, D-dimer, pH, urea, ferritin, and lactate dehydrogenase levels at first admission were statistically significant factors for the prediction of mortality in the training cohort. By using multivariate logistic regression analysis, all of these statistically significant parameters were used to produce Biruni Index. Statistically significant differences in Biruni Index were observed between ex and non-ex groups in both training and validation cohorts (P < 0.001 for both comparisons). Areas under receiver operating characteristic (ROC) curve for Biruni Index were 0.901 (95CI%: 0.864-0.938, P < 0.001) and 0.860 (95CI%: 0.795-0.926, P < 0.001) in training and validation cohorts, respectively. CONCLUSION: As a pioneering clinical study, Biruni Index may be a useful diagnostic tool for clinicians to predict the mortality in critically ill patients with COVID-19 hospitalized due to severe viral bronchopneumonia. However, Biruni Index should be validated with larger series of multicenter prospective clinical studies.

Comparison of Cytokine Hemadsorption as an Immunomodulator Therapy in COVID-19 Patients with and without Bacterial Sepsis.

BACKGROUND: In this retrospective study, we aimed to compare the laboratory and clinical results of cytokine hem-adsorption as an immunomodulation therapy in COVID-19 ICU patients with or without sepsis. METHODS: The levels of PCT, CRP, and ferritin were determined as indicators of infection/sepsis; the levels of in-terleukins (IL-6, IL-8 and IL-10, and TNF-α) were determined as indicators of cytokine storm were compared. APACHE score, SOFA score, and mortality rates were compared for the progression of the disease in 23 COVID-19 patients. RESULTS: The therapy was generally successful in reducing the levels of IL-6, IL-8, IL-10, and TNF-α but the levels measured after the procedure did not differ among the patients with or without sepsis, suggesting that the presence of sepsis did not affect the efficacy and function of the cytokine hemadsorption procedure in COVID-19 patients. All parameters were reduced after the procedure except the levels of PCT and ferritin and mortality rates of patients diagnosed with sepsis. The level of PCT was significantly higher in these patients compared with the patients without sepsis while the ferritin and mortality did not show any significant difference between the two groups, suggesting that the cytokine hemadsorption may be safe in the treatment of critical COVID-19 patients. CONCLUSIONS: As a result, the progression of sepsis in COVID-19 may be avoided with cytokine hemadsorption applied as an immunomodulator therapy. However, this therapy should be further explored and validated prior to its introduction to everyday clinical practice when the epidemic conditions end.

Can the Reduction of Cytokines Stop the Progression of Sepsis?

Objective In this study, we aimed to analyze the laboratory and clinical results of cytokine hemadsorption as an immunomodulation therapy in ICU patients diagnosed with sepsis or septic shock. Methods The levels of procalcitonin (PCT) and C-reactive protein (CRP), determined to be indicators of infection/sepsis, and the levels of interleukins (IL-6, IL-8, and IL-10) and tumor necrosis factor α (TNFα), deemed as indicators of the cytokine storm, were compared among 32 patients before and after the hemadsorption procedure. Results The hemadsorption significantly reduced the levels of IL-6, IL-8, IL-10, TNFα, PCT, CRP, Acute Physiology and Chronic Health Evaluation (APACHE) scores, mortality rate, and Sequential Organ Failure Assessment (SOFA) scores (p<0.05). APACHE scores and the mean predicted mortality rate (PMR) of the non-survivors measured before the procedure was significantly higher than those of survivors (p=0.002 for both). IL-10, APACHE scores, and the mortality rates determined before the hemadsorption procedure were deemed significant parameters to predict the mortality among all ICU patients (p<0.05). IL-10 levels ≤125.3 ng/L, APACHE score >30, and PMR >70.33 were significantly associated with the mortality rates of all patients, indicating that these three parameters determined before the hemadsorption may be good predictors of mortality among ICU patients with sepsis. Conclusion The progression of sepsis in ICU patients may be prevented with cytokine hemadsorption applied as an immunomodulator therapy.

Anxiety and depression in the first 24 h in COVID-19 patients who underwent non-invasive mechanical ventilation in the intensive care unit.

BACKGROUND AND AIMS: The aim of this study was to investigate the degree of anxiety and depression in the first 24 h of people who were taken to the intensive care unit (ICU) due to COVID-19 and had to use unfamiliar devices in an unfamiliar environment. MATERIAL METHOD: Sixty-two patients over 18 years of age, conscious and cooperative, who were admitted to the ICU with the diagnosis of COVID, were PCR (+), and needed non-invasive mechanical ventilation were included in the study. Age, gender, Acute Physiology and Chronic Health Evaluation (APACHE) II scores, and Hospital Anxiety Depression (HAD) A (anxiety), and HAD D (depression) scores of the patients were recorded, and the prevalence of anxiety and depression and independent factors affecting them were investigated. RESULTS: The mean age of the patients was 57.1 ± 17.6 years, and the mean APACHE II was 29.3 ± 10.4. The average HAD A score was 10.5 ± 3.5 in all patients, while the HAD D score was 10.5 ± 3.3. The prevalence of anxiety was 37.1% (23 patients), and the prevalence of depression was 43.6% (27 patients). Age and APACHE II and anxiety/depression were negatively correlated, and when age and APACHE II scores increased, anxiety and depression decreased (p < 0.05). CONCLUSION: In COVID-19 patients who underwent non-invasive mechanical ventilation in the ICU, the rate of anxiety in the first 24 h of admission was 37.1% while for depression the rate was 43.6%. In addition, advanced age and high APACHE II scores were found to be associated with low anxiety and depression. TRIAL REGISTRATION: ClinicalTrials ID: NCT04715477 (January 20, 2021).

Anesthesia or analgesia? New block for shoulder surgery: pericapsular nerve group block.

Interscalene brachial plexus (ISB) block is considered the analgesic technique of choice for shoulder surgery. However, the hemidiaphragmatic paresis that may occur after the block has led to the search for an alternative to the ISB block. In this case report, the pericapsular nerve group (PENG) block was performed for both surgical anesthesia and postoperative analgesia in two patients who underwent shoulder surgery. It is suggested that the PENG block can be safely applied for analgesia and can be part of surgical anesthesia, but alone is not sufficient for anesthesia. The block of this area did not cause motor block or pulmonary complications, nor result in muscle laxity, blocking only the shoulder and the upper third of the humerus. It was demonstrated that the PENG block may be safely applied for both partial anesthesia and analgesia in selected shoulder surgery cases.

Secondary traumatic stress, anxiety, and depression among emergency healthcare workers in the middle of the COVID-19 outbreak: A cross-sectional study.

BACKGROUND: This study aims to determine the secondary traumatic stress (STS), anxiety, and depression levels of the emergency healthcare workers (HCWs) and to identify the factors associated with the mental health of the emergency HCWs. METHODS: This prospective cross-sectional study was performed between April 1 and May 1, 2021. Emergency nurses and auxiliary staff who gave informed consent were included in the study. Participants who answered the questions incompletely were excluded from the study. Demographic information, working and living conditions, STS, anxiety, depression scores, and coping strategies were recorded. RESULTS: A total of 363 HCWs were included in the study. STS was detected in 261 (71.9%) of the participants, anxiety in 148 (40.8%), and depression in 203 (55.9%) participants. Vaccination against COVID-19 was not associated with STS, anxiety, and depression among emergency HCWs (p > 0.05). Having financial difficulties was the most important factor in the development of anxiety, depression, and STS (OR: 3.68 (95% CI 1.96-6.90), p < 0.001; OR: 4.36 (95% CI 2.52-7.53), p < 0.001; OR: 5.35 (95% CI 3.06-9.37), p < 0.001, respectively). We found significantly reduced levels of STS, anxiety, and depression among participants reporting coping strategies that engaging in hobbies, healthy nutrition, and reading books. CONCLUSION: High levels of STS, anxiety, and depression were determined among emergency nurses and auxiliary staff during the pandemic. Poor job satisfaction and financial difficulties were associated with the mental health of emergency HCWs. The mental health of the emergency HCWs should be evaluated regularly. In addition to professional psychological support, social and financial support should be provided as well.

Effect of Different Kinds of Music on Anxiety During Implant Surgery in Turkey: Randomized Controlled Study.

PURPOSE: Dental anxiety causes patients to avoid or delay dental treatments. This delay leads to more serious dental problems, which can then lead to more invasive and expensive treatment with possible emergency situations. The purpose of this study was to determine the most successful and effective kind of music to lessen the anxiety of patients during dental implant surgery. MATERIALS AND METHODS: This study was a prospective observational randomized controlled study. Eighty dental implant surgery patients aged between 40 and 70 years were chosen for the study. Patients were divided into four groups: group 1-classic Turkish music group (Saba or Rast Tune); group 2-classical music (Vivaldi); group 3-slow rock music; and group 4-control group. Blood pressures, heart rate, and O2 saturations of the patients were evaluated along with Corah's Dental Anxiety Survey (CDAS) at admittance. After 5 minutes of music in the room, the same evaluations were recorded, and the survey was repeated. RESULTS: All the groups with music treatment had a significant decrease in anxiety levels. It was observed that listening to music had a positive effect on dental anxiety regardless of the kind of music. There were significant differences in CDAS values postoperatively. Turkish music and classical music were much more effective in diminishing dental anxiety compared with soft rock music (P = .000 and .002, respectively). CONCLUSION: This study indicated that regardless of the kind of music, listening to music diminishes dental anxiety significantly; Turkish music and classical music were the most effective kinds of music.

Evaluating the Relationship between the Pleth Variability Index and Hypotension and Assessing the Fluid Response in Geriatric Hip Fracture under Spinal Anaesthesia: An Observational Study.

OBJECTIVE: We aimed to test the efficacy of the pre-operative Pleth variability index (PVI) in evaluating hypotension that developed after spinal anaesthesia in patients who were spontaneously breathing, pre-operatively hypovolemic, and were at an advanced age. METHODS: This observational study included 94 patients aged >65 years with hip fracture. Demographic data, pre-operative heart rate, non-invasive arterial pressures, PVI values, and haemogram values were continuously measured following spinal anaesthesia. The measurements with and without hypotension were distinguished and their data were compared. RESULTS: The mean age of the patients was 77.4±8.2 years. In total, 56.4% of the patients developed hypotension after spinal anaesthesia, and hypotension was higher in women (p=0.037). Low pre-operative diastolic arterial pressures values were associated with the development of hypotension (p=0.037). The relationship between PVI and post-spinal hypotension was negative but significant (r=-0.239; p<0.05). Depending on the volume loss, an increase in the PVI (p<0.001) and its subsequent significant decrease after treatment in patients with hypotension (p<0.001) was observed. The correlation between noninvasively measured haemoglobin values and the values obtained from arterial blood gas samples was significant (p<0.001). CONCLUSION: This study showed that post-spinal hypotension may be associated with increased as well as decreased PVI values. However, these values cannot be clinically used for predicting pre-operative hypotension in hypovolemic patients.

The Correlation between Preoperative and Postoperative Hypoalbuminaemia and the Development of Acute Kidney Injury with Respect to the KDIGO Criteria in the Hip Fracture Surgery in Elderly Patients.

OBJECTIVE: The aim of the present study was to determine the correlation between preoperative and postoperative hypoalbuminaemia and acute kidney injury (AKI) in the hip fracture surgery in elderly patients. METHODS: A total of 160 patients aged ≥65 years were scanned retrospectively. They were grouped into four as the preoperative albumin level of <3.8, preoperative albumin level of >3.8, postoperative day 2 albumin level of <2.9 and postoperative day 2 albumin level of >2.9. In the beginning and 7 days, age, gender, white blood cell, haemoglobin, haematocrit, glucose, blood urea nitrogen, serum creatinine, albumin values, fever, anaesthesia method, presence of blood transfusion, surgical period, hospitalisation durations and expenses in the postoperative period were recorded for all the patients. RESULTS: In the study, 92 women and 68 men were scanned. AKI was observed in 28 (17.5%) patients, and 16 (57.1%) patients were determined in stage 1. AKI development in Group 1 and Group 3 was significantly high (p<0.05). Advanced age, multiple drug usage, postoperative glucose level and blood product transfusion during the operation were significantly associated with AKI (p<0.05). The hospitalisation period and cost were high in patients with AKI (p<0.05). CONCLUSION: It was determined that hypoalbuminaemia was associated with AKI development, and preoperative or postoperative hypoalbuminaemia affected AKI development at similar rates. Advanced age, multiple drug usage, postoperative glucose level and blood product transfusion during the operation were associated with AKI.

Comparing Different Music Genres in Decreasing Dental Anxiety in Young Adults Who Underwent Third Molar Surgery in Turkey: Randomized Controlled Trial.

PURPOSE: The purpose of this study was to determine the music genre reducing anxiety best in patients whose third molars were extracted. MATERIALS AND METHODS: Eighty patients were included in this prospective, observational, randomized controlled trial. They were divided into 4 groups: group 1, Turkish music; group 2, classical music of a Western culture; group 3, soft rock music; and group 4, no music (control group). The preoperative blood pressure, heart rate (HR), and oxygen saturation of each patient were measured, and the Corah Dental Anxiety Scale (CDAS) questionnaire was applied, with the values being measured and recorded at 5-minute intervals. Descriptive and bivariate statistics were computed, and the P value was set at .05. RESULTS: Of the 80 patients, 44 were women and 36 were men. The average age was 24.1 ± 5.9 years. No significant differences between the groups were found in terms of age; gender; or preoperative HR, mean arterial pressure, oxygen saturation (as measured by pulse oximetry), and CDAS values (P > .05). Although no significant correlations was found between anxiety levels and age (P = .330), HR (P = .694), or mean arterial pressure (P = .775), it was detected that anxiety was high in women (P < .05). Anxiety levels decreased at all times in all groups, but the postoperative CDAS values of the classical music group were significantly lower than those of the other groups (P = .024). CONCLUSIONS: This study found that classical Western music that was started in the preoperative period and continued until the end of the operation significantly reduced the anxiety associated with third molar extraction in patients aged between 18 and 30 years.

Impact of Pre-Emptive Intravenous Ibuprofen on Perioperative Analgesia in Patients Undergoing Third Molar Extraction: A Randomised Controlled Study.

OBJECTIVE: The aim of the present study was to evaluate the analgesic efficacy of pre-emptive intravenous (iv) ibuprofen on pain during and after the mandibular third molar surgery. METHODS: A total of 60 patients were included in the study. They were allocated as ibuprofen 800 mg iv+dexketoprofen 50 mg (group 1), ibuprofen 800 mg iv alone (group 2) or placebo (group 3). A local anaesthetic infiltration was administered to all patients. In all patients, haemodynamic values (mean arterial pressure (MAP) and heart rate (HR)) were recorded preoperatively, and infusions were started. State-Trait Anxiety Inventory (STAI) scale was used to assess anxiety states. Surgery started 15 min after the infusion. Haemodynamic values and pain scores with visual analogue scale (VAS) were recorded. Pain scores were recorded postoperatively at rest (VASR) and swallowing (VASS). RESULTS: There was no significant difference in the preoperative STAI values between the groups (p>0.05). HR, MAP and VAS pain scores were significantly higher in group 3 than in groups 1 and 2 (p<0.05). VASR and VASS scores were significantly higher in group 3 than in group 1 in the first 4 h postoperatively (p<0.05). VASS scores were significantly higher in group 3 than in group 2 at 1-4 h postoperatively (p<0.05), but there was no difference in VASR and VASS scores at 48 h after surgery. CONCLUSION: Ibuprofen alone or in combination with dexketoprofen provided similar analgesia in the perioperative period when administered pre-emptively.

Can endocan be a new biomarker in ventilator-associated pneumonia?

Ventilator-Associated Pneumonia (VAP) is a hospital-acquired bacterial infection with high incidence and mortality rate. The aim of this study is to investigate the correlation between the Endocan level and development of VAP and whether or not this correlation was correlated with the clinical findings. Demographic data, white blood cell (WBC) count, procalcitonin (PCT), c-reactive protein (CRP), and fever levels of 60 patients were recorded in serial measurements for 5 days. When there was the presence of fever or elevated Endocan, alveolar lavage culture was taken and chest radiographies were taken. Correlations of the Endocan levels with the culture results and laboratory values were examined. The rate of VAP was found as 10.4/1000 mechanical ventilator days. Endocan levels were significantly higher in patients with VAP (p < 0.05). However, there was no significant difference among PCT, WBC, CRP measurements (p > 0.05). No correlation was found between Endocan levels and PCT, WBC and CRP levels in those with VAP (p > 0.05). A significant correlation was found between the Endocan level and the elevated fever 24 h later (p:0.001). The serum Endocan level on the day 3 had a specificity of 73.3%, a sensitivity of 68.9%, positive predictive value of 44%, and negative predictive value of 88.5% at the cut off level of 9.17 ng/mL. In this study, it was determined that high Endocan levels were associated with the development of VAP. The present study suggested that Endocan can be used as a screening tool for the development of VAP. CLINICAL TRIALS.GOV ID: NCT02916277.

Can Perfusion Index be used as an Objective Tool for Pain Assessment in Labor Analgesia?

OBJECTIVE: To establish a relationship between the Visual Analog Scale for pain (VAS) in the recovery time of epidural analgesia and the Perfusion Index (PI) values at that time and to test the possibility of using PI as an objective tool for pain assessment. METHODS: Thirty women were included in the study. After inserting epidural catheter, the initial applicationtime of epidural analgesia was taken as 0th minute. Hemodinamics, VAS, and PIvalues were recorded at 5th, 10th, 30th, 60th minutes and every two hours until the birth and the 30th minute after the birth. RESULTS: HR, SAP, DAP, PI, VAS values before the procedure were different than all follow-ups (p<0.001). A negative and significant correlation was found at 10th, 30th, 60th minutes and 2nd hour after drug administration from epidural catheter(rho:0.38; p:0.03, rho:0.47; p:0.009, rho:0.75; p<0.001, rho:0.46; p:0.009, respectively). As the pain decreased, the perfusion index increased. In 17 patients requiring additional doses, PI increased after the all medications, but a decrease was observed in the VAS values(p<0.05). CONCLUSIONS: In this study, it was determined that the pain decreased with epidural analgesia, perfusion index increased and the pain level increased significantly when the perfusion index started to decrease.

Use of sugammadex in Rett syndrome: A case report.

Rett syndrome (RS) is a neurodevelopmental disorder characterized by loss of cognitive, motor, and social skills, epilepsy, autistic behavior, abnormal airway patterns, gastroesophageal reflux, nutritional problems, and severe scoliosis. Although girls with RS show normal or near-normal growth until 6-8 months, they lose their skills after that. The anesthetic management of these patients requires care because of all these clinical features. Especially in the postoperative period, prolonged apnea is common and extubation is delayed. In this case report, the effect of using sugammadex was presented in a 16-year-old girl with RS. The patient's all bimaxillary teeth and 4 wisdom teeth were extracted under general anesthesia in one session with minimal surgical trauma and moderate bleeding. Sugammadex can be a rapid and reliable agent for the reversal of the neuromuscular block in neurodegenerative patients.

Effect of preemptive intravenous ibuprofen on postoperative edema and trismus in third molar tooth extraction: A randomized controlled study.

BACKGROUND: This study aimed to evaluate the anti-inflammatory efficacy of preemptive intravenous ibuprofen on inflammatory complications such as edema and trismus in patients undergoing impacted mandibular third molar surgery. METHODS: Sixty patients were included and divided into three groups (800 mg IV ibuprofen + 50 mg dexketoprofen, 800 mg IV ibuprofen, and control). In all patients, preoperative hemodynamic values were recorded before the infusions. The operation was started at 15-min post-infusion. Evaluation of edema size on the face and mouth opening (trismus) was conducted in the preoperative period, and at postoperative 48 h and 1 week. RESULTS: No difference was determined among the groups in trismus and edema size in postoperative measurements (P > 0.05). There was a difference between group 2 and group 3 only in measurement value of tragus-corner of the mouth on the postoperative day 2 (P < 0.05). A difference was found between the measurement values of trismus preoperatively and at preoperative day 2, and between postoperative day 2 and 1 week in group 3 based on time (P < 0.05). In group 3, edema on the face on postoperative day 2 increased significantly compared to that in the preoperative period (P < 0.001); in addition, edema increased significantly in groups 1 and 2 in the postoperative period but was less than that in group 3 (P < 0.001). CONCLUSIONS: In this study, intravenous ibuprofen was determined to be more effective alone or in combination in alleviating trismus and to better limit the postoperative edema.

What Is the Best Pulmonary Physiotherapy Method in ICU?

Objective. Effects of high frequency chest wall oscillation technique were investigated on intubated ICU patients. Background. Thirty intubated patients were included in the study. The control group (n = 15) received routine pulmonary rehabilitation technique. In addition to the pulmonary rehabilitation technique, the study group (n = 15) was given high frequency chest wall oscillation (HFCWO). APACHE II, dry sputum weight, lung collapse index, and blood gas values were measured at 24th, 48th, and 72nd hours and endotracheal aspirate culture was studied at initial and 72nd hour. The days of ventilation and days in ICU were evaluated. Results. There is no significant difference between APACHE II scores of groups. The dry sputum weights increased in the study group at 72nd hour (p = 0.001). The lung collapse index decreased in study group at 48th (p = 0.003) and 72nd hours (p < 0.001). The PO2 levels increased in the study group at 72nd hour (p = 0.015). The culture positivity at 72nd hour was decreased to 20%. The days of ventilation and staying in ICU did not differ between the groups. Conclusions. Although HFCWO is very expensive equipment, combined technique may prevent the development of lung atelectasis or hospital-acquired pneumonia more than routine pulmonary rehabilitation. It does not change intubated period and length of stay in ICU. However, more further controlled clinical studies are needed to use it in ICU.

Effects of Fentanyl and Morphine on Shivering During Spinal Anesthesia in Patients Undergoing Endovenous Ablation of Varicose Veins.

BACKGROUND We sought to investigate the effect of morphine and fentanyl on shivering when used adjunctively with bupivacaine during spinal anesthesia in patients undergoing varicose vein surgery on an outpatient basis. MATERIAL AND METHODS The study included a total of 90 patients, aged 25-45 years, ASA I-II, scheduled to undergo endovenous laser ablation under spinal anesthesia for lower extremity venous insufficiency/varicose vein disease. Patients were randomly allocated into 3 groups: Group M (morphine group) received 5 mg 0.5% hyperbaric bupivacaine + 0.1 mg morphine, Group F (fentanyl group) received 5 mg 0.5% hyperbaric bupivacaine + 25 µg fentanyl, and Group C (control group) received 5 mg 0.5% hyperbaric bupivacaine + physiologic saline. The level of sensory blockade was assessed with pin-prick test and the level of motor blockade was assessed with Bromage scale at 5-min intervals. Shivering grade and time to first postoperative analgesic requirement was recorded. RESULTS Level and time of sensory block showed a slight but insignificant increase in the Morphine Group and Fentanyl Group. Time of postoperative analgesic requirement was significantly longer in patients who received morphine (p<0.05). Shivering was significantly less common in patients who received morphine and fentanyl than in patients who are in the Control Group (p<0.02). CONCLUSIONS Morphine or fentanyl may be used as adjunctives to spinal anesthesia to prevent shivering in patients undergoing venous surgery.