Nephrotoxicity caused by colistin use in ICU: a single centre experience.

BACKGROUND: We aimed to determine the risk factors that may be associated with colistin-induced acute kidney injury (AKI) to promote the safer use of colistin in the treatment of nosocomial infections caused by multidrug-resistant Gram-negative bacteria in intensive care units. MATERIALS AND METHODS: This retrospective observational study was conducted among adult patients who received a minimum of 48 h of intravenous colistin from January 2020 to December 2020 at the intensive care unit of a tertiary care hospital. AKI diagnosis and staging were made based on the Kidney Disease Improving Global Outcome Criteria. RESULTS: Of 148 patients who received intravenous colistin at a daily dose of 9 million IU, 54 (36%) developed AKI. In the univariate analysis, age, Charlson comorbidity index, APACHE II score, duration of colistin treatment, basal creatinine level, use of vasopressors, and vancomycin were significantly associated with AKI (p < 0.05). The multivariate analysis revealed that the independent predictor of AKI was the use of vasopressors (OR: 3.14; 95% confidence interval: 1.39-97.07; p = 0.06). CONCLUSION: The use of vasopressors in critically ill patients was independently associated with AKI developing during colistin treatment.

The Impact of CoronaVac Vaccination on 28-day Mortality Rate of Critically Ill Patients with COVID-19 in Türkiye.

Background: Vaccines against coronavirus disease-19 (COVID-19) have been effective in preventing symptomatic diseases, hospitalizations, and intensive care unit (ICU) admissions. However, data regarding the effectiveness of COVID-19 vaccines in reducing mortality among critically ill patients with COVID-19 remains unclear. Aims: To determine the vaccination status and investigate the impact of the COVID-19 vaccine on the 28-day mortality in critically ill patients with COVID-19. Study Design: Multicenter prospective observational clinical study. Methods: This study was conducted in 60 hospitals with ICUs managing critically ill patients with COVID-19. Patients aged ≥ 18 years with confirmed COVID-19 who were admitted to the ICU were included. The present study had two phases. The first phase was designed as a one-day point prevalence study, and demographic and clinical findings were evaluated. In the second phase, the 28-day mortality was evaluated. Results: As of August 11, 2021, 921 patients were enrolled in the study. The mean age of the patients was 65.42 ± 16.74 years, and 48.6% (n = 448) were female. Among the critically ill patients with COVID-19, 52.6% (n = 484) were unvaccinated, 7.7% (n = 71) were incompletely vaccinated, and 39.8% (n = 366) were fully vaccinated. A subgroup analysis of 817 patients who were unvaccinated (n = 484) or who had received two doses of the CoronaVac vaccine (n = 333) was performed. The 28-day mortality rate was 56.8% (n = 275) and 57.4% (n = 191) in the unvaccinated and two-dose CoronaVac groups, respectively. The 28-day mortality was associated with age, hypertension, the number of comorbidities, type of respiratory support, and APACHE II and sequential organ failure assessment scores (p < 0.05). The odds ratio for the 28-day mortality among those who had received two doses of CoronaVac was 0.591 (95% confidence interval: 0.413-0.848) (p = 0.004). Conclusion: Vaccination with at least two doses of CoronaVac within six months significantly decreased mortality in vaccinated patients than in unvaccinated patients.

The relationship between lung fibrosis, the epidermal growth factor receptor, and disease outcomes in COVID-19 pneumonia: a postmortem evaluation.

The aim of this study was to examine the relationship between the severity of fibrosis in lung tissue and epidermal growth factor receptor (EGFR) positivity in patients who died due to COVID-19 pneumonia, demographic characteristics, comorbidities, biochemical values, and treatments received. Fifty patients who died from COVID-19 pneumonia were included in the study. Demographic data for the patients, laboratory tests, thorax computerized tomography findings, comorbidities, length of stay in the intensive care unit (ICU), intubation times, and treatments given were noted. Postmortem Tru-cut lung biopsy was performed. EGFR positivity was examined and grouped as negative, mild, moderate, and severe. Data were analyzed statistically. EGFR involvement was negative in 11 (22%), mild in 20 (40%), moderate in 13 (26%), and severe in 6 (12%) patients. The mean C-reactive protein (CRP) values, D-dimer values, and mean length of stay in the ICU were found to be significantly different between the groups (p = 0.024; p = 0.003; p = 0.016, respectively). Methylprednisolone dose and the presence of comorbidity did not differ significantly in EGFR involvement (p = 0.79; p = 0.98, respectively). CRP and D-dimer values can be used as a guide to assess the severity of pulmonary fibrosis that develops in severe COVID-19 pneumonia patients. The dose of methylprednisolone used does not make a significant difference in the severity of fibrosis.Trail registration: Clinical Trials.gov identifier date and number 01/13/2022 NCT05290441.

Investigation of SARS-CoV-2 in Postmortem Ocular Tissues and Evaluation of Its Effects on Corneal Donation.

PURPOSE: The purpose of this study was to investigate the presence of viruses in postmortem nasopharyngeal swabs and ocular tissues of patients with coronavirus disease 19 (COVID-19) confirmed through an antemortem reverse transcription polymerase chain reaction (RT-PCR) test. METHODS: We recorded demographic data, comorbidities, treatments, and vaccination status of the patients diagnosed with COVID-19 and monitored in the intensive care unit. Nasopharyngeal swab samples were collected from the patients within 2 hours postmortem followed by swabs from both eyes, lower and upper conjunctival sacs, corneal epithelial layer, and samples from anterior chamber fluid. The geneMAP 2019-nCoV severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) detection kit was used to detect the samples showing the presence of SARS-CoV-2. RESULTS: Among the 47 patients (mean age 74 years, range 39-92) included in the study, 29 were men and 18 were women. The nasopharyngeal swab samples of 21 patients were positive for the RT-PCR test for SARS-CoV-2, whereas at least one of the ocular tissue samples in 6 of those patients were positive for the RT-PCR test for SARS-CoV-2. However, all ocular swab samples were tested negative for SARS-CoV-2 in the 26 patients with negative nasopharyngeal swab samples. The mean duration from COVID-19 diagnosis to mortality was 10 days (range 2-27 days) in patients with positive postmortem nasopharyngeal swab samples for SARS-CoV-2, compared with an average of 21 days (1-80 days) in patients who tested negative. This difference was statistically significant (P = 0.01). CONCLUSIONS: Cadavers with negative postmortem nasopharyngeal swab samples for SARS-CoV-2 and those with the time from diagnosis to death of >3 weeks may be considered as candidates for corneal donation.

Adjuvant Hypnotherapy for Hyperemesis Gravidarum: A Randomized Pilot Study.

Hyperemesis gravidarum, which requires hospitalization in approximately 1% to 5% of patients, is characterized by severe nausea and vomiting in pregnancy. This study investigated the effects of hypnosis on nausea, vomiting, use of antiemetic medications, and hospital stay among patients diagnosed with hyperemesis gravidarum. Patients were randomized to receive either conventional therapy alone (control condition, n = 23) or adjuvant hypnotherapy plus conventional therapy (treatment group, n = 18). Sociodemographic data, severity of nausea, frequency of vomiting per day, rescue medications used, and length of hospital stay were recorded. Participants in the treatment group received 2 sessions of hypnosis and were instructed in daily self-hypnosis practice. Those in the control group received treatment as usual. Results from this study indicated that adjunctive use of hypnotherapy with patients diagnosed with hyperemesis gravidarum experienced significantly reduced severity of nausea and frequency of vomiting compared to treatment-as-usual alone. Also, hospital stay was found to be shorter in the treatment group as compared to the control group. These findings are encouraging and suggest it is feasible and potentially beneficial to include adjunctive hypnotherapy to treat hyperemesis gravidarum.

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.

Incidence, characteristics and risk factors of medical device-related pressure injuries: An observational cohort study.

OBJECTIVES: This study aimed to investigate the cumulative incidence, characteristics, and risk factors of medical device-related pressure injuries (MDRPIs), including patient outcomes, in the intensive care unit (ICU) of a university hospital. RESEARCH METHODOLOGY/DESIGN: A prospective observational cohort study. SETTING: The study was conducted in an university hospital between November 2019 and October 2020. METHODS: The study included patients over the age of 18 years who had a device in situ and stayed in the ICU for more than 24 h. Each device was monitored twice a day for 15 days; the clinical assessment was performed daily until ICU discharge or death. The Case Report Form, MDRPI Monitoring Form, Sequential Organ Failure Assessment (SOFA) score, Acute Physiology and Chronic Health Evaluation (APACHE-II), Braden Scale, National Pressure Injury Advisory Panel (NPIAP) staging and categories, and Glasgow Coma Scale (GCS) were used for data collection. Patients with and without MDRPIs were compared for demographic and clinical characteristics, length of ICU stay, and mortality by using t-test and Chi-square test. Cumulative incidence was calculated. Logistic regression model was used to investigate risk factors. RESULTS: The incidence rate of MDRPIs was 48.8% (84/172 patients). Most of the MDRPIs developed in the mucosa; hence, they could not be staged (63.7%). Of the remaining MDRPIs on the skin, 18.7%, 13%, and 4.6% were categorized as Stage I, II, and III, respectively. In terms of anatomical locations, most commonly occurred in the head and neck region (62.3%). Among the twelve medical devices that caused MDRPIs, endotracheal tubes (61 cases), urinary catheters (46 cases), nasogastric tubes (30 cases) and non-invasive masks (17 cases) were most commonly reported. In multivariate analysis, age (46-64 years) (p = 0.008, OR = 12.457), history of cardiovascular diseases (p = 0.021, OR = 0.044), administration of vasopressors (p = 0.013, OR = 0.089), length of ICU stay (≥22 days, p = 0.048, OR = 0.055) and requirement for mechanical ventilation (p = 0.028, OR = 10.252) were identified as independent risk factors of the occurrence of MDRPI. CONCLUSIONS: This study provides a comprehensive understanding of the risk of MDRPI in critically ill adults. The incidence of MDRPIs was high and was associated with several factors. It is critical that MDRPIs are taken seriously by all members of the healthcare team, especially nurses, and that protocols should be established for improvements.

Cerebral Malaria Treated with Artemisinin in the Intensive Care Unit: A Case Report.

Malaria is a parasitic disease that is starting to be encountered in intensive care units (ICU) worldwide, owing to increasing globalisation. Severe malaria caused by Plasmodium falciparum, is characterised by cerebral malaria, acute renal failure, hypoglycaemia, severe anaemia, splenomegaly and alveolar oedema. We present the case of a 25-yr old male patient who presented to the Emergency Department of Uludag University in Bursa, Turkey in the winter of 2014 with complaints of fever for three days. His medical history revealed a 14-month stay in Tanzania. Staining of blood smears revealed characteristic gametocytes in accordance with P. falciparum infection. The day after admission, he had an epileptic seizure after which his Glasgow Coma Scale was 6, so he was intubated and transferred to the ICU. A computerized tomography scan revealed findings of cerebral oedema. Intravenous mannitol was administered for 6 days. Intravenous artemisinin was continued for 10 days. Due to refractory fevers, anti-malarial treatment was switched to quinine and doxycycline on the 14th day and on the 16th day the fevers ceased. This case emphasizes that cerebral malaria should be suspected in cases of seizures accompanying malaria, and treatment should be initiated in the ICU. Furthermore, resistance of P. falciparum to artemisinin should be in mind when a response to therapy is lacking.