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.

Comparison of ultrasound-guided quadratus lumborum block and erector spinae plane block in terms of their effects on postoperative pain in open nephrectomy.

BACKGROUND: Ultrasound-guided quadratus lumborum block (QLB 2) and erector spinae plane block (ESPB) were suggested to prevent somatic and visceral pain in a small number of abdominal surgeries. In this study, we aimed to compare these fascial plane blocks in terms of efficacy and safety in patients undergoing open nephrectomy. METHODS: This double-blind randomized controlled trial included a total of 40 patients (aged 18-70 years, with an ASA Score of I-III) and underwent partial or radical nephrectomy with subcostal incision. Unilateral ESPB and QLB 2 were performed at the end of the operation. The patients were then assessed for total morphine consumption, pain scores, and side effects at the postoperative 24th hour. RESULTS: The ESPB and QLB 2 groups showed similar total morphine consumption (20.95+12.40 mg and 25.05+13.60 mg, P=0.870) and morphine demands (37.85+29.43 and 41.15+31.75, P=1.000), respectively. Despite the lower VAS scores at rest and movement in the ESPB group, there were no statistically significant differences between groups. CONCLUSIONS: Ultrasound-guided QLB 2 and ESP block were found to achieve similar results on at rest and at movement pain scores and morphine consumption of the patients undergoing open nephrectomy. Both blocks may be preferred, depending on the clinician's experience.

Characteristics and outcomes of 974 COVID-19 patients in intensive care units in Turkey.

BACKGROUND: In our previous report on Turkish COVID-19 patients requiring intensive care, the 24 patients in a single ICU were elderly and mortality was high. We extended our analysis to include patients admitted to ten ICUs. OBJECTIVES: Report the demographics, clinical features, imaging findings, comorbidities, and outcomes in COVID-19 patients. DESIGN: Retrospective. SETTING: Intensive care unit. PATIENTS AND METHODS: The study includes patients with clinical and radiological confirmed or laboratory-confirmed COVID-19 infection who were admitted to ten ICUs between 15 March and 30 June 2020. MAIN OUTCOME MEASURES: Clinical outcomes, therapies, and death during hospitalization SAMPLE SIZE: 974, including 571 males (58%). RESULTS: The median age (range) was 72 (21-101) years for patients who died (n=632, 64.9%) and 70 (16-99) years for patients who lived (n=432, 35.2%) (P<.001). APACHE scores, and SOFA scores were higher in patients who died than in those who survived (P<.001, both comparisons). Respiratory failure was the most common cause of hospitalization (82.5%), and respiratory failure on admission was associated with death (P=.013). Most (n=719, 73.8%) underwent invasive mechanical ventilation therapy. CONCLUSIONS: The majority of patients admitted to the ICU with a diagnosis of COVID-19 require respiratory support. LIMITATIONS: Although the Turkish Ministry of Health made recommendations for the treatment of COVID-19 patients, patient management may not have been identical in all ten units. CONFLICT OF INTEREST: None.

Anesthetic management of a patient with face hemangioma: case report.

Anesthetic agents and/or surgical positions, the total volume of hemangioma may increase under general anesthesia; thus, airway management of patients with a hemangioma may be very difficult. Our patient in this case report has a periorbital and oropharyngeal hemangioma that reaches down to the esophagus. We observed that the size and volume of the hemangioma increased significantly during elective nephrectomy surgery. After adequate therapy with steroids and beta-blockers, the size of the hemangioma decreased during the postoperative care unit monitoring period. We report this case to show the importance of airway management of hemangiomas with the potential for life-threatening complications.

Diagnostic and Therapeutic Approaches to Novel COVID-19 in Intensive Care Unit: A Narrative Review.

This study aimed to compile the up-to-date information about the methods and pharmacological agents used in the diagnosis and treatment of coronavirus disease 2019 (COVID-19) and examine the methods used in the treatment of COVID-19 in patients in the intensive care unit by reviewing the treatment guidelines published by national health authorities worldwide. We surveyed the literature published on the novel coronavirus (severe acute respiratory syndrome [SARS] coronavirus [SARS-CoV-2]) before April 25, 2020, in PubMed. The results of the study identified serological and molecular methods (e.g., real-time reverse transcriptase polymerase chain reaction) used by physicians for diagnosing COVID-19 and identified thorax computed tomography along with other imaging methods used for determining the severity of the disease. However, it was concluded that the desired developments for treatment and vaccination have not been achieved till today, and many of the agents used and studied for the treatment were drugs previously used for the treatment of Middle East respiratory syndrome and SARS. COVID-19 has higher levels of transmissibility and pandemic risk. The available information revealed that, given the size and scope of the pandemic, to date, there has been no scientifically proven effective medicine and vaccines against SARS-CoV-2. There is also an urgent need for further research for finding an effective medicine and vaccine for COVID-19 to prevent the occurrence of an outbreak in future and manage such public health emergency of this magnitude in both short and long terms.

Cases of Brain Death and Organ Donation Rates in Eskisehir.

Brain death is defined as the irreversible loss of brain and brainstem functions, making organ harvesting legally possible. We have aimed to determine the current donation and harvesting rates in Eskisehir, Turkey to achieve further donation rates by improving the conditions. We have analyzed the data of brain death cases from Eskisehir Osmangazi University Hospital and 2 state hospitals based on a time interval between 2013 and 2017. The evaluation of 113 cases of brain death revealed that organ harvesting could be performed in 25.7% of those cases, whereas organ donation was not approved in 74.3% of those deceased patients due to refusal of the legally responsible relatives. The results of a study carried out in Bursa as the first-ranked province in the Organ Donation List of Turkey in 2012 suggested that relatives permitted organ donation in only 34.6% of 79 brain death cases between 2007 and 2014, whereas that rate was 8.8% of 4.9 cadaver donations per million persons in Bursa, Turkey. A comparison between the results of Eskisehir and a neighboring province showed that lower rates of organ donation in Eskisehir may be caused by absence of a transplantation center in the province, therefore, putting the transplantation center of the university hospital into service will accelerate the rates of organ donation in Eskisehir.

Delayed Post-Traumatic Anisocoria.

Post-traumatic carotid artery dissection is one of the major causes of ischemic stroke in young patients; its diagnosis remains a challenge for clinicians because of its variable clinical presentation. An otherwise healthy 37-year-old man was referred to the intensive care unit of our faculty for the management of multiple trauma because of a car accident. At 11 days from admission, his doctor noticed the advent of anisocoria. A prompt treatment was instituted with anti-platelet and-coagulant agents. The patient had a complete resolution of symptoms. The prognosis was good, and the patient achieved a complete clinical recovery. He was discharged without any sequelae.

Synthetic Cannabinoid 'Bonzai' Intoxication: Six Case Series.

In the language of the streets, 'bonzai', known as '1-naphthalenyl of methanol', also known as JWH-18 group, is a drug belonging to the group of synthetic cannabinoids. At the beginning of 2004, it started to be sold on the internet and it is seen that private markets. It has structurally similar chemical characteristics as delta 9-tetrahydrocannabinol (THC), the active substance in marijuana. In 2013, in a study conducted by the European Monitoring Centre of Drugs and Drug Addiction (EMCDDA), 102 varieties of synthetic cannabinoids were identified; however, more than 200 substances have been reported since 1997. In this study, we report the difficulties in the clinical course, treatment and management of six patients that had a use history of bonzai although it was not detected in blood in a short period of time in the intensive care unit.

Cholorhexidine, octenidine or povidone iodine for catheter related infections: A randomized controlled trial.

BACKGROUND: Protection of the catheter site by antimicrobial agents is one of the most important factors in the prevention of infection. Povidone iodine and chlorhexidine gluconate are the most common used agents for dressing. The purpose of this study was to compare the effects of povidone iodine, chlorhexidine gluconate and octenidine hydrochloride in preventing catheter related infections. MATERIALS AND METHODS: Patients were randomized to receive; 4% chlorhexidine gluconate, 10% povidone iodine or octenidine hydrochlorodine for cutaneous antisepsis. Cultures were taken at the site surrounding catheter insertion and at the catheter hub after removal to help identify the source of microorganisms. RESULTS: Catheter related sepsis was 10.5% in the povidone iodine and octenidine hydrochlorodine groups. Catheter related colonization was 26.3% in povidone iodine group and 21.5% in octenidine hydrochlorodine group. CONCLUSION: 4% chlorhexidine or octenidine hydrochlorodine for cutaneous disinfection before insertion of an intravascular device and for post-insertion site care can reduce the catheter related colonization.

Prevention of etomidate-related myoclonus in anesthetic induction by pretreatment with magnesium.

BACKGROUND: Etomidate frequently leads to myoclonic jerks during anesthetic induction. This study aimed to detect if pretreatment with magnesium decreases myoclonus incidence. METHODS: A hundred ASA (the American Society of Anesthesiologists) I-II patients were included and randomized into 2 groups. Three minutes before etomidate induction of anesthesia (by 0.3 mg/kg intravenous etomidate), Group M received 2.48 mmol (60 mg) intravenous magnesium sulphate and Group P received equal volume of intravenous saline. Myoclonus was evaluated as "present/absent". RESULTS: The rate of myoclonus was significantly lower in Group M than in Group P (p < 0.01). Hemodynamic parameters revealed no significant difference between the two groups. CONCLUSIONS: Low dose magnesium pretreatment before etomidate induction of anesthesia significantly reduces unwanted myoclonic jerks and also protects the hemodynamic stability.

The effects of N-acetylcysteine on hepatic function during isoflurane anaesthesia for laparoscopic surgery patients.

INTRODUCTION: Although most general anaesthesia procedures are performed without any complications, volatile agents may have adverse effects on various living systems. This study aims to compare the antioxidant effects of isoflurane and N-acetylcysteine (NAC) on liver function. METHODS: Forty-one patients in the ASA I-II risk groups, who were scheduled to undergo gynaecologic laparoscopy, were randomly divided into two groups: The placebo (group P, n=21) and the NAC group (group N, n=20). In both groups, anaesthesia was maintained with 1-2% isoflurane in 50% Oxygen-50% N(2)O at 6 l/min, also administered by inhalation. Venous blood samples were obtained before anaesthesia induction, and then in the postoperative 1(st) hour and at the 24(th) hour. The samples were centrifuged and serum levels of glutathione S-transferase (GST), malondialdehyde (MDA), aspartate amino transferase (AST), alanine amino transferase (ALT), lactate dehydrogenase (LDH), gamma glutamyltranspeptidase (GGT), prothrombin time (PT), activated partial thromboplastin time (aPTT) and international normalised ratio were determined. RESULTS: GST levels were significantly higher in group N than in group P in the postoperative 1(st) hour. Postoperative values of GST in the two groups were higher when compared to preoperative values (P<0.05). When postoperative levels were compared with preoperative levels, the postoperative MDA levels of group N were significantly higher (P<0.05). Levels of AST, ALT, GGT and LDH in both groups revealed significant decreases at the postoperative 1(st) hour and postoperative 24(th) hour compared to preoperative values (P<0.05, P<0.001). PT values were significantly higher in both groups in the postoperative 1(st) hour and 24(th) hour (P<0.05, P<0.001), although there were no differences in aPTT levels. CONCLUSION: Our results showed that liver functions were well preserved with administration of NAC during anaesthesia with isoflurane. Isoflurane with NAC has lesser effect on liver function tests compared to isoflurane alone.

Role of glutamine administration on cellular immunity after total parenteral nutrition enriched with glutamine in patients with systemic inflammatory response syndrome.

Glutamine is an important substrate for enterocyte and other rapidly proliferating cells. Low plasma and tissue levels present in glutamine in critically ill patients suggest that demand may exceed endogenous supply. Because commercially available amino acid solutions do not contain glutamine because of its instability in aqueous solution, conventional total parenteral nutrition (TPN) does not prevent stress-induced glutamine depletion. In this study, we administered intravenous glutamine-supplemented TPN to patients with systemic inflammatory response syndrome (SIRS) to investigate the effect of glutamine supplementation on immune states. This study is a prospective, randomized clinical trial. All patients received TPN given continuously for 6 days. Thirty patients with SIRS were allocated to either a glutamine group (l-glutamine 0.4g/[kg d]) (n = 15) or a control group (n = 15). Blood samples were collected on day 1 and day 6 after admission for C-reactive protein, immunoglobulin (Ig) M, IgG, IgA, C(3), C4, and lymphocyte analysis. The Acute Physiologic and Chronic Health Evaluation II score and the Simplified Acute Physiologic II (SAPS II) score were used to evaluate the patients after admission. Although there was a tendency for decreased T cytotoxic cells and natural killer cells in the control group, no significant difference was observed between the 2 groups. However, an increase in lymphocyte and lymphocyte subgroups in the glutamine group was observed; but there was no difference between the groups. A low SAPS II score was observed on the sixth day in the glutamine group, whereas no difference in SAPS II and Acute Physiologic and Chronic Health Evaluation II scores was observed between the 2 groups. There was no difference in IgM, IgG, IgA, C(3), and C4 levels and numbers of B-lymphocytes between the groups. Glutamine-added TPN significantly decreases leukocyte and natural killer cell count and therefore suppresses inflammation. Furthermore, total lymphocyte count, B- and T-lymphocytes, and their subgroups (helper T-lymphocytes, cytotoxic T-lymphocytes) are increased; although not statistically significant, these increases might be playing a role in improving the immune system.

The assessment of QT intervals in acute carbon monoxide poisoning.

OBJECTIVE: Carbon monoxide (CO) poisoning is known to cause myocardial toxicity and life threatening arrhythmias. QT interval measured from electrocardiogram is an indirect measure of the heterogeneity of ventricular repolarization, which may contribute to ventricular arrhythmias. The purpose of the study was to investigate whether the carboxyhemoglobin (COHb) level may be related to the changes of QT, corrected QT (QTc), QT dispersion (QTd), corrected Qtd (QTdc) and cardiac enzymes during carbon monoxide poisoning. METHODS: We conducted an observational study; 104 patients who had been diagnosed with CO intoxication were included in the study. Measurement of QT, QTc, QTd and QTdc intervals were performed form electrocardiogram on admission, 24 and 48 hours after admission. Cardiac enzymes were measured at each time-point. The myocardial perfusion scan was determined in all patients 1 week after admission. RESULTS: The QT interval level in 24 h was significantly higher than admission level (p<0.001), additionally QTc interval levels in 24 h and 48 h were significantly lower than admission levels (p<0.001 and p<0.001, respectively). Carboxyhemoglobin level only significantly correlated with QT intervals (r=-0.288 ; p=0.019), troponin T (r=-0.297; p=0.007), and creatine kinase MB levels (r=0.262; p=0.020). As a result of ROC analysis the QT interval level was significantly powerful parameter to predict COHb (p=0.022). CONCLUSION: Our data indicate COHb level correlated with QT intervals and cardiac enzymes. Clinicians should possibly avoid QT prolonging drugs and carefully monitor the QT, QTc, QTdc intervals in patients at high risk of cardiac disability due to high levels of COHb after CO poisoning.

A comparison of analgesic efficacy of tramadol and pethidine for management of postoperative pain in children: a randomized, controlled study.

Prevention of postoperative pain in children is one of the most important objectives of the anesthesiologist. Opioids have been used as an analgesic for postoperative pain in children for many years. Tramadol has both opioid and monoaminergic agonist actions. The aim of the study was to determine if the analgesic potency and occurrence of adverse effects of tramadol differ from pethidine when administered to children. A total of 110 healthy children, aged 2-12 years, scheduled for elective lower abdominal surgery were randomized to receive either pethidine 1 mg/kg (Group I, n = 60) or tramadol 2 mg/kg (Group II, n = 50) for postoperative pain after anesthesia induction. Pain intensity, adverse effects, heart rate, and systolic and diastolic blood pressure were recorded at regular intervals. The mean pain scores on postoperative 24 h were significantly greater with tramadol than with pethidine. Sedation scores, heart rate and systolic and diastolic blood pressure showed no significant differences between the groups. We conclude that pethidine and tramadol are effective in providing analgesia in pediatric patients, but pethidine provided better postoperative analgesia than tramadol. Changes in blood pressure, heart rate and arterial oxygen saturation were minimal and were similar in both drugs.

The effects of dopexamine in bupivacaine and ropivacaine induced cardiotoxicity in isolated rat heart.

OBJECTIVE: To compare the inotropic and chronotropic effects of ropivacaine and bupivacaine in an isolated, spontaneously beating rat heart, and to determine the reversal effects of dopexamine on these effects. METHODS: The study was conducted at the Department of Physiology, Medical Faculty, Osmangazi University, Eskisehir, Turkey in November 2001. Fifty animals were randomly assigned to 5 groups. Hearts were perfused with a modified Krebs Henseleit solution. In group I (n=10) hearts were exposed to bupivacaine 5 x 10-6 M and in group II (n=10) hearts were exposed to ropivacaine 5 x 10-6 M for 15 minutes. Group III (n=10) was the dopexamine control group and hearts were exposed to dopexamine 1 x 10-6 M for 5 minutes. In group IV (n=10) and in group V (n=10) hearts were exposed to dopexamine in 1 x 10-6 M doses immediately after the bupivacaine and ropivacaine infusions. Heart rates and contractile forces were recorded continuously during the study. RESULTS: Both of the local anesthetics had cardiac depressant effect on isolated hearts. Bupivacaine created more significant effect on heart rate and contractility than ropivacaine. Hearts receiving dopexamine after the infusion of local anesthetic, recovered more quickly. CONCLUSION: Bupivacaine had more depressant effects on cardiac contractility and chronotropy than ropivacaine. Dopexamine may provide an alternative to presently recommended pharmacological therapy in cases of bupivacaine and ropivacaine induced cardiotoxicity. But, the clinical impact of the use of dopexamine in this situation deserves further evaluation.