Aspiration of Fractured Tracheostomy Tube in a Prone Positioned COVID-19 Patient: A Case Report and Review of the Literature.

A 61-year-old male patient diagnosed with Coronavirus disease 2019 (COVID-19) acute respiratory distress syndrome (ARDS) was managed with tracheostomy and intermittent prone positioning in the intensive care unit. After a sudden deterioration, examination of tracheostomy tube (TT) and X-ray of the chest revealed that he had aspirated the fractured TT. The fractured tube was removed through the tracheostomy stoma using a rigid ventilating bronchoscope and forceps. Prone positioning is a beneficial postural therapy capable of improving patient oxygenation. However, it has some complications, like unplanned extubation and facial tissue injury. Percutaneous tracheostomy is also a valuable and safe procedure and has been increasingly performed in critical care patients, including those who suffer from COVID-19 ARDS. Fractures and aspiration of a tracheostomy tube can occur anytime after tracheostomy. We think prone positioning may contribute to the rupture and aspiration of the tracheostomy tube in this study.

Does hospitalisation of a patient in the intensive care unit cause anxiety and does restriction of visiting cause depression for the relatives of these patients during COVID-19 pandemic?

OBJECTIVES: During the pandemic, anxiety and depression may occur increasingly in the whole society. The aim of this study was to evaluate the possible cause, incidence and levels of anxiety and depression in the relatives of the patients in the intensive care unit (ICU) in accordance with the patients' SARS-CoV-2 polymerase chain reaction (PCR) result. MATERIALS AND METHOD: The study was prospectively conducted on relatives of patients admitted to tertiary intensive care units during COVID-19 pandemic. Sociodemographic characteristics of the patients and their relatives were recorded. "The Turkish version of the Hospital Anxiety and Depression Scale" was applied twice to the relatives of 120 patients to determine the symptoms of anxiety and depression in accordance with the PCR results of the patients (PCR positive n = 60, PCR negative n = 60). RESULTS: The ratios above cut-off values for anxiety and depression among relatives of the patients were 45.8% and 67.5% for the first questionnaire and 46.7% and 62.5% for the second questionnaire, respectively. The anxiety and depression in the relatives of PCR-positive patients was more frequent than the PCR negative (P < .001 for HADS-A and P = .034 for HADS-D). The prevalence of anxiety and depression was significantly higher in female relatives (P = .046 for HADS-A and P = .009 for HADS-A). There was no significant correlation between HADS and age of the patient or education of the participants. The fact that the patients were hospitalised in the ICU during the pandemic was an independent risk factor for anxiety (AUC = 0.746) while restricted visitation in the ICU was an independent risk factor for depression (AUC = 0.703). CONCLUSION: Positive PCR and female gender were associated with both anxiety and depression while hospitalisation in the ICU due to COVID-19 was an independent risk factor for anxiety and restricted visitation in the ICU is an independent risk factor for depression.

Melkersson-Rosenthal Syndrome: A Rare Cause of Recurrent Facial Nerve Palsy and Acute Respiratory Distress Syndrome.

Melkersson-Rosenthal Syndrome (MRS) is a rare disease characterized by persistent or recurrent orofacial oedema, relapsing peripheral facial paralysis, and furrowed tongue. Pathologically, granulomatosis is responsible for oedema of face, labia, oral cavity, and facial nerve. We present a patient with MRS admitted to our hospital with acute respiratory distress syndrome (ARDS). 45-year-old woman was admitted to an emergency department with dyspnea and swelling on her hands and face. She was intubated because of ARDS and accepted to intensive care unit (ICU). After weaning from ventilatory support, peripheral facial paralysis was diagnosed and steroid treatment was added to her therapy. On dermatologic examination, oedema on her face, pustular lesions on her skin, and fissure on her tongue were detected. The patient informed us about her recurrent and spontaneous facial paralysis in previous years. According to her history and clinical findings, MRS was diagnosed.

Copeptin: a new predictor for severe obstructive sleep apnea.

INTRODUCTION: Copeptin which is the C-terminal fragment of antidiuretic hormone (ADH), is a biomarker that has been reported to be increased in various cardiovascular disorders, cerebrovascular diseases and associated with prognosis. Patients with obstructive sleep apnea syndrome (OSAS) have a tendency to develop coronary and cerebral atherosclerotic diseases. OBJECTIVES: The aim of the present study was to study copeptin levels in patients with obstructive sleep apnea and in a control group in order to determine whether copeptin could be used as a biomarker predicting the severity of OSAS and possible complications in this group. METHODS: A total of 116 patients with OSAS, diagnosed by polysomnography, and 27 controls were included in the study. Blood samples were collected after overnight fasting, and copeptin levels were measured with enzyme-linked immunosorbent assay. RESULTS: Copeptin levels were significantly higher in the OSAS group compared to control group (2,156±502; 1,845±500 pg/mL, respectively, P=0.004). Mean copeptin level of the patients having apnea-hypopnea index (AHI) ≥30 was significantly higher than that of the patients having AHI <30 (2,392±415; 2,017±500 pg/mL, respectively, P<0.001). A multivariate regression analysis showed that copeptin level, (hazard ratio: 1.58; 95% confidence interval: 1.09-2.30) was a predictor of severe OSAS (P=0.016). Copeptin levels showed significant positive correlation with AHI (r=0.32; P<0.001), desaturation index (r=0.23; P=0.012), arousal index (r=0.24; P=0.010) and CRP (r=0.26; P=0.011) respectively. CONCLUSION: Copeptin levels are high in OSAS patients and copeptin is a potential marker for identifying patients with a high risk of early cardiovascular complications of OSAS. Copeptin has modest sensitivity (84%) for discriminating severe OSAS patients who are candidates for severe cardiovascular complications.

Arterial stiffness measured via carotid femoral pulse wave velocity is associated with disease severity in COPD.

BACKGROUND: Patients with COPD face an increased risk of cardiovascular disease and increased cardiac mortality. Carotid femoral pulse wave velocity (cf-PWV) is a validated measure of arterial stiffness, a well recognized predictor of adverse cardiovascular outcomes, and offers higher predictive value than classical cardiovascular risk factors. We investigated the association between COPD and arterial stiffness using cf-PWV as a noninvasive technique. METHODS: This clinical study was prospective, observational, and cross-sectional. Sixty-two subjects with stable COPD and 22 healthy controls underwent physical examination, chest x-rays, pulmonary function tests, arterial blood gas analysis, and 6-min walk test, and cf-PWV was measured via a validated tonometry system. RESULTS: The COPD subjects had greater arterial stiffness than the control subjects, and that difference was associated with lower FEV1, PaO2, and oxygen saturation during the 6-min walk test. We observed higher cf-PWV in the COPD subjects with severe COPD than in the subjects with mild to moderate COPD. Only FEV1 was an independent predictor of cf-PWV. CONCLUSIONS: Our results suggest that arterial stiffness is increased in subjects with more severe and advanced COPD than in those with mild to moderate COPD. Air flow limitation and hypoxemia may induce increased arterial stiffness in COPD patients.

High serum YKL-40 level in patients with COPD is related to hypoxemia and disease severity.

Chronic obstructive pulmonary disease (COPD) is a major health problem with increasing morbidity and mortality throughout the world. YKL-40 is a chitin-binding glycoprotein consisting of 383 amino acids, with a molecular mass of 40 kDa, and its serum level is elevated in inflammatory diseases. YKL-40 is a newly recognized biomarker of inflammation and has not been thoroughly investigated in COPD. The aim of the study is to investigate the relationship between serum YKL-40 levels and severity of COPD. The study population consisted of 52 patients with COPD with the mean age of 60.2 ± 10.1 years. The serum YKL-40 level increased significantly with increasing age (p = 0.022, r = 0.346). In COPD patients, high serum YKL-40 level is correlated to low forced expiratory volume at 1 second (FEV1, percent of predicted) (r = -0.277, p = 0.047). Moreover, high serum YKL-40 level is correlated to low arterial oxygen pressure (PaO2, mmHg) (r = -0.387, p = 0.005). The mean serum YKL-40 level was found as 243.1 ± 129.2 ng/ml in COPD patients with desaturation during 6-minute walk test (6MWT) and this value was higher than the mean serum YKL-40 level (155.8 ± 59.1 ng/ml) of COPD patients without desaturation during 6MWT (p = 0.004). This study demonstrated that high serum YKL-40 levels were correlated to severity of COPD. We propose that circulating YKL-40 levels could be a biomarker for hypoxemia and decline in lung function.

In situ thrombosis in pulmonary arterial aneurysms due to Behçet's disease and efficacy of immunosuppressive therapy.

BehçetDisease (BD) is a systemic vasculitis characterized by recurrent oral and genital ulcers and uveitis, arthritis, and involvement of the gastrointestinal tract, central nervous system and blood vessels. The aneurysms of the pulmonary arteries, with or without thrombosis, are typical manifestation of BD. We report a case with BD, pulmonary arterial aneurysms(PAA) and in situ thrombosis. We aimed to show the effectiveness of immunosuppressive treatment on in situ thrombosis in a case with PAA and BD.

Bronchiolitis as a feature of kartagener syndrome: a case report.

Kartagener syndrome (KS), also known as immotile cilia syndrome or as a primary ciliary dyskinesia, is characterized by the triad of situs inversus, bronchiectasis, and chronic pansinusitis. A few studies reported that diffuse bronchiolitis might be one of the characteristic features of the lung in KS. We aimed to present the radiologic characteristics of KS, including diffuse bronchiolitis, sinus aplasia, and situs inversus totalis in a single case.

Mounier-kuhn syndrome: a case report.

Mounier-Kuhn syndrome is a rare clinical and radiologic entity characterized by the pathologic dilatation of the trachea and bronchi. The clinical features consist of expiratory central airway collapse, airflow limitation, and clinical presentation similar to chronic bronchitis. A 73-year-old man was admitted to the hospital with the complaints of cough, sputum, dyspnea, and recurrent bronchitis. The radiologic, spirometric, and bronchoscopic findings showed the Mounier-Kuhn syndrome. We describe characteristic bronchoscopic and spirometric features of the Mounier-Kuhn syndrome.