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.

Effect of early awake prone positioning application on prognosis in patients with acute respiratory failure due to COVID-19 pneumonia: a retrospective observational study.

BACKGROUND: We evaluated the effect of early awake prone position administration on oxygenation and intubation requirements and short-term mortality in patients with acute respiratory failure due to coronavirus disease 2019 (COVID-19) pneumonia. METHODS: This is an observational-cohort study. Patients receiving mask oxygen therapy in our intensive care units because of acute respiratory failure due to COVID-19 pneumonia were included. The Awake Prone Position (APP) group consisted of patients who were applied awake prone position, whereas non-APP group consisted of patients who were not applied awake prone position. PaCO2, PaO2, pH, SpO2 values and PaO2/FiO2 ratios were recorded at the beginning and 24th hour. Demographic data, comorbidities, intubation requirements, ventilator-free days, length of intensive care unit stay and short-term mortality of the patients were recorded. RESULTS: The data of total 225 patients were examined, and 48 patients who met our study criteria were included. At the 24th hour, the median SpO2 value of the APP group was 95%, the median PaO2 value was 82 mmHg, whereas the SpO2 value of the non-APP group was 90% and the PaO2 value was 66 mmHg. (p = 0.001, p = 0.002). There was no statistically significant difference between the groups in length of intensive care unit stay and ventilator-free days, but short-term mortality and intubation requirements was lower in the APP group (p = 0.020, p = 0.001) CONCLUSION: Awake prone position application in patients receiving non-rebreather mask oxygen therapy for respiratory failure due to COVID-19 pneumonia improves oxygenation and decreases the intubation requirements and mortality.

Impact of HFNC application on mortality and intensive care length of stay in acute respiratory failure secondary to COVID-19 pneumonia.

BACKGROUND: In Covid-19 pneumonia, high mortality rates reported in intubated patients have raised non-invasive methods of respiratory support. OBJECTIVE: We aimed to evaluate the impact of HFNC application on intubation requirement, intensive care length of stay, and short-term mortality in patients with COVID-19 pneumonia. MATERIAL-METHOD: Patients receiving oxygen by reservoir mask or HFNC therapy in our intensive care units due to COVID-19 pneumonia were included in the study. Group H consisted of patients who received HFNC, and Group K consisted of patients who received conventional oxygen therapy (COT). The number of patients intubated, duration of intensive care stay and short-term mortality were recorded. RESULTS: 43 patients were included. The short-term mortality and the number of patients with intubation need was lower in Group H. There was no significant difference between the Groups in the length of intensive care stay. CONCLUSION: Administration of HFNC in respiratory failure secondary to COVID-19 pneumonia decreases the need for intubation and mortality.

A new scoring system for early diagnosis of ventilator-associated pneumonia: LUPPIS.

INTRODUCTION: The Clinical Pulmonary Infection Score (CPIS) based on chest X-ray has been developed to facilitate clinical diagnosis of ventilator-associated pneumonia (VAP); however, this scoring system has a low diagnostic performance. We developed the Lung Ultrasound and Pentraxin-3 Pulmonary Infection Score (LUPPIS) for early diagnosis of VAP and evaluated the performance of this new scoring system. MATERIAL AND METHODS: In a prospective study of 78 patients with suspected VAP, we assessed the detection accuracy of LUPPIS for pneumonia in adult patients. We also evaluated the diagnostic performance of pentraxin-3 (PTX-3) findings of infection. On the day of the study, lung ultrasound was performed, PTX-3 levels were determined, and an endotracheal aspirate was obtained for Gram staining and culture. RESULTS: No significant differences were found between groups with respect to age, mechanical ventilation time, APACHE II score, or SOFA score (p > 0.05). Procalcitonin and PTX-3 levels were significantly higher in the VAP (+) group (p < 0.001 and p < 0.001, respectively). The threshold for LUPPIS in differentiating VAP (+) patients from VAP (-) patients was > 7. In predicting VAP, LUPPIS > 7 (sensitivity of 84%, specificity of 87.7%) was superior to CPIS > 6 (sensitivity of 40.1%, specificity of 84.5%). CONCLUSIONS: LUPPIS appears to provide better results in the prediction of VAP compared to CPIS, and the importance of lung ultrasound and PTX-3 is emphasized, which is a distinctive property of LUPPIS.

The Role of Transocular Ultrasound in the Assessment of Neurotoxicity-Related Encephalopathy in Mushroom Poisoning.

OBJECTIVE: Mushroom poisonings can lead to life-threatening organ dysfunctions and neurotoxicity-related encephalopathy. This study aimed to detect increased intracranial pressure by measuring optic nerve sheath diameter (ONSD) ultrasonographically and to determine its association with clinical and laboratory parameters. METHODS: In this prospective case-control study, we evaluated the patients aged above 18 years who presented to the emergency department with mushroom poisoning. Vital signs, clinical and laboratory parameters and ONSD of both eyes measured with transocular ultrasound were noted at initial admission and the 24th hour. RESULTS: We measured ONSD in 26 cases with mushroom poisoning and 26 healthy volunteers. Baseline ONSD measurements of the poisoning group were significantly higher than those of the control group (5.94±0.73 vs. 4.11±0.64, p<0.0001). ONSD values significantly regressed at 24th hour compared with the baseline measurements in the poisoning group (5.94±0.73 vs. 5.06±0.56, p<0.001).The ONSD values were significantly higher in patients who had a clinical picture of encephalopathy compared with patients who didn't have (6.05±0.72 vs. 4.36±1.03, p<0.001). No significant deterioration was observed in ammonium levels, hepatic and renal functions of the patients. CONCLUSION: We detected increased ONSDs in patients with mushroom poisoning compared with those in the control healthy volunteers. Our findings suggest that ONSD, measured by ultrasonography, may be safely and effectively used to diagnose transient encephalopathy associated with neurotoxicity.

Abdominal perfusion pressure is superior from intra-abdominal pressure to detect deterioration of renal perfusion in critically Ill patients.

BACKGROUND: Intra-abdominal hypertension (IAH) is a frequent cause of acute kidney injury (AKI) among critically ill patients who have risk factors. This study aimed to determine the relation between Abdominal Perfusion Pressure (APP) and AKI showed by the Doppler-based renal resistive index (RRI). METHODS: In this study, 38 patients older than 18 years old who received mechanical ventilation and had risk factors for the development of IAH were prospectively studied. All measurements and parameters were divided into two groups according to renal dysfunction (Group I: RRI <0.72 vs Group II: RRI >0.72). RESULTS: The mean IAPs were not significant between the groups, 11.5±6.9 mm Hg in Group I (n=35) and 13.5±5.8 in Group II (n=33), respectively. APPs were statistically higher in Group I (81.2±13.6) than Group II (66.4±9.5) (p<0.001). The AUC for the association between APP at RRI >0.72 was 0.802 (p<0.001), with the APP ≤72 mmHg having a sensitivity of the 76% (95% CI 58-89%) and a specificity of 71% (95% CI 54-85%). CONCLUSION: Our findings suggest that an APP with a threshold of ≤72 mmHg is associated with a significant increase in renal RRI, which may be predictive of worsening of renal perfusion.

Diagnostic Accuracy of Procalcitonin for Differentiating Bacteraemic Gram-Negative Sepsis from Gram-Positive Sepsis.

OBJECTIVE: The identification of bacteraemia in patients with suspected sepsis is crucial for survival. A cheap, fast and reliable biomarker, which can predict the causative pathogen group, may be useful to confirm or exclude the presence of bacteraemia. This study aimed to evaluate the relationship between procalcitonin (PCT) and the causative pathogen in intensive care patients with sepsis and bacteraemia. METHODS: Patients with diagnosed sepsis, a positive blood culture and measured serum procalcitonin levels during their intensive care unit stay were included in the study. Demographic data, PCT level, leukocyte count, C-reactive protein level, creatinine level, lymphocyte count, leukocyte/lymphocyte ratio and the group of the pathogen that detected in the blood culture were retrospectively recorded. RESULTS: Overall, 136 sepsis patients who were diagnosed with bacteraemia were included in the study. The PCT level was 7.31 ng mL-1 in the gram-negative group and 0.46 ng mL-1 in the gram-positive group. For PCT, the sensitivity was 70.83% and the specificity was 84.21%, with the cut-off value being ≤1.3. The area under the receiver operating characteristics curve for PCT was 0.80. CONCLUSION: Patients with gram-negative sepsis had higher PCT values than those with gram-positive sepsis. Our results suggest that PCT value may be a useful tool for distinguishing between gram-negative and gram-positive bacteraemia.

The effects of genistein supplementation on fructose induced insulin resistance, oxidative stress and inflammation.

AIMS: This experimental study was designed to investigate the effects of 10weeks genistein administration on oxidative stress and inflammation in serum and liver of rats fed with fructose. MAIN METHODS: 6-8weeks old, 40 male Sprague-Dawley rats were included. Group 1 (control) was fed with standard chow food and 100µl/kg/day/rat dimethyl sulfoxide (DMSO) administered subcutaneously; group 2 (genistein) with standard chow food and 0.25mg/kg/day/rat genistein; group 3 (fructose) with standard chow food and drinking water 20% fructose, group 4 (fructose+genistein) with standard chow food, drinking water with 20% fructose and 0.25mg/kg/day/rat genistein. TNF-α, IL-6, visfatin as inflammatory markers and 8-isoprostane as a oxidative stress marker were measured by ELISA, glucose, triglyceride, total cholesterol, LDL-cholesterol and HDL-cholesterol by enzymatic colorimetric method, AST and ALT by kinetic UV method. KEY FINDINGS: Significantly high 8-isoprostane levels in serum (p<0.001) and liver (p<0.05) in group 3 compared to control group indicate that presence of oxidative stress. Significantly high TNF-α and IL-6 levels in serum (p<0.05) and liver (p<0.01) and visfatin levels in serum (p<0.001) of group 3 indicate inflammation accompanying insulin resistance and oxidative stress. Genistein administration to fructose group causes a significant decrease in HOMA-IR (p<0.001) and LDLC (p<0.05) level. Significantly lower serum 8-isoprostane (p<0.01) level indicates the antioxidant effect of genistein and significantly lower liver TNF-α (p<0.01), serum, liver IL-6(p<0.01) and serum visfatin (p<0.01) levels reflect the antiinflammatory effects of genistein. SIGNIFICANCE: Genistein administration to rats fed with fructose causes an ameliorating effect on HOMA-IR values and lipid status markers in addition to its antioxidant and antiinflammatory effects.

Investigating the correlation of the number of diagnostic criteria to serum adiponectin, leptin, resistin, TNF-alpha, EGFR levels and abdominal adipose tissue.

AIM: Cardiovascular diseases are among the leading causes of morbidity and mortality in developed countries. Metabolic syndrome is a common clinical presentation posing significant risk in cardiovascular diseases. This study investigated the correlation between the number of diagnostic criteria and serum adiponectin, leptin, resistin, TNF-alpha, EGFR levels and abdominal adipose tissue in the individuals with metabolic syndrome. MATERIALS AND METHODS: This study included a total of 40 patients (18 men and 22 women) with metabolic syndrome that applied to the Internal Diseases Outpatient Clinic of Ümraniye Training and Research Hospital between March 2011 and August 2011. The data including age, gender, personal history, familial history, habits, height, weight, systolic blood pressure, diastolic blood pressure, body mass index, waist circumference, hip circumference, body composition (tanita) were recorded for each patient. Blood samples were collected for biochemical examinations. The serum adiponectin, leptin, resistin, TNF-alpha, EGFR levels were measured. Statistical analyses were carried out using the NCSS (Number Cruncher Statistical System) 2007 and the PASS (Power Analysis and Sample Size) 2008 Statistical Software (UT, USA). RESULTS: When the patients with metabolic syndrome were analyzed by gender, no statistically significant difference was found between the EGFR and TNF-alpha levels (p>0.05). On the other side, the visceral fat rating and GGT levels of women were significantly lower than those of men (p<0.05). However, the resistin and leptin levels were found significantly higher in female patients as compared to male patients (p<0.05). CONCLUSION: In the present study, we did not observe any statistically significant change in abdominal adipose tissue thickness, serum TNF-alpha, adiponectin, resistin, and EGFR levels of the patients according to the number of diagnostic criteria; however, there was significant change in the patients' leptin levels.