Prediction of mortality in COVID-19 through combing CT severity score with NEWS, qSOFA, or peripheral perfusion index.

INTRODUCTION: The assessment of disease severity and the prediction of clinical outcomes at early disease stages can contribute to decreased mortality in patients with Coronavirus disease 2019 (COVID-19). This study was conducted to develop and validate a multivariable risk prediction model for mortality with using a combination of computed tomography severity score (CT-SS), national early warning score (NEWS), and quick sequential (sepsis-related) organ failure assessment (qSOFA) in COVID-19 patients. METHODS: We retrospectively collected medical data from 655 adult COVID-19 patients admitted to our hospital between July and November 2020. Data on demographics, clinical characteristics, and laboratory and radiological findings measured as part of standard care at admission were used to calculate NEWS, qSOFA score, CT-SS, peripheral perfusion index (PPI) and shock index (SI). Logistic regression and Cox proportional hazard models were used to predict mortality, which was our primary outcome. The predictive accuracy of distinct scoring systems was evaluated by the receiver-operating characteristic (ROC) curve analysis. RESULTS: The median age was 50.0 years [333 males (50.8%), 322 females (49.2%)]. Higher NEWS and SI was associated with time-to-death within 90-days, whereas higher age, CT-SS and lower PPI were significantly associated with time-to-death within both 14 days and 90 days in the adjusted Cox regression model. The CT-SS predicted different mortality risk levels within each stratum of NEWS and qSOFA and improved the discrimination of mortality prediction models. Combining CT-SS with NEWS score yielded more accurate 14 days (DBA: -0.048, p = 0.002) and 90 days (DBA: -0.066, p < 0.001) mortality prediction. CONCLUSION: Combining severity tools such as CT-SS, NEWS and qSOFA improves the accuracy of predicting mortality in patients with COVID-19. Inclusion of these tools in decision strategies might provide early detection of high-risk groups, avoid delayed medical attention, and improve patient outcomes.

Evaluation of the relationship between the topographical anatomy in the axillary region of the brachial plexus and the body mass index.

To investigate the topographic anatomy of the median, musculocutaneous, radial and ulnar nerves with respect to the axillary artery and to seek whether these configurations are associated with baseline descriptive data including age, gender, and body-mass index. This cross-sectional trial was carried out on 199 patients (85 women, 114 men; average age: 46.78 ± 15.45 years) in the department of anaesthesiology and reanimation of a tertiary care center. Topographic anatomy of the median, musculocutaneous, radial and ulnar nerves was assessed with ultrasonography. Localization of these nerves with respect to the axillary artery was marked on the map demonstrating 16 zones around the axillary artery. Frequencies of localizations of every nerve in these zones were recorded, and the correlation of these locations with descriptive data including age, gender and BMI was investigated. There was no difference between women and men for the distribution of the median (p = 0.74), ulnar (p = 0.35) and radial (p = 0.64) nerves. However, the musculocutaneous nerve was more commonly located in Zone A13 in men compared to women (p = 0.02). The localization of the median (p = 0.85), ulnar (p = 0.27) and radial (p = 0.88) nerves did not differ remarkably between patients with BMI < 25 kg/m2 and patients with BMI ≥ 25 kg/m2. Notably, the musculocutaneous nerve was more often determined in Zone A10 in cases with BMI ≥ 25 kg/m2 (p = 0.001). Our results imply that the alignment of the musculocutaneous nerve may vary in men and overweight people. This fact must be considered by the anaesthetist before planning the axillary block of brachial plexus. All these informations may enlighten the planning stages of the brachial plexus blockade.

Comparison of the effects of various airway devices on hemodynamic response and QTc interval in rabbits under general anesthesia.

UNLABELLED: In this study, we aimed to compare the effects of various airway devices on QTc interval in rabbits under general anesthesia. The subjects were randomly separated into four groups: Group ETT, Group LMA, Group PLA, Group V-gel. Baseline values and hearth rate, mean arterial pressure and ECG was obtained at the 1st, 5th and 30th minutes after administration of anesthesia and placement of airway device and, QTc interval was evaluated. Difference was observed between ET group and V-gel group in the 5th minute mean arterial pressure values (p < 0.05). It was observed that QTc intervals at the 1st and 5th minute in the ET group significantly increased when compared with the other groups (p < 0.05). Again, it was observed that QTc interval of ET group at the 15th and 30th minute was longer when compared with PLA and V-gel groups (p < 0.05). It was also observed that QTc interval of LMA Group at the 5th minute after intubation significantly increased when compared with V-gel group (p < 0.05). It was observed that HR values of ETT group at the 1st, 5th and 15th minutes after intubation increased with regards to PLA and V-gel groups (p < 0.05). It was determined that the 30th minute hearth rate of ETT group was higher when compared to V-gel group (p < 0.05). CONCLUSION: In our study we observed that V-gel Rabbit affected both hemodynamic response and QT interval less than other airway devices.

Protective role of Proanthocyanidin in experimental ovarian torsion.

BACKGROUND: Proanthocyanidin is a potent bioactive antioxidant naturally occurring in grape seed and acts as reactive oxygen species (ROS) scavenger. The aim of this study was to investigate the effects of proanthocyanidinin in experimental ovarian torsion injury. METHODS: Twenty four rats were randomly divided into three groups (n=8). Group 1: the laparotomy group, group 2: ovarian torsion group, and group 3: intervention group administered proanthocyanidinin of 50 mg/kg before bilateral ovarian ischemia and reperfusion. Histologic examination and scoring was done at the end of the experiment. Statistical analyses were performed using the SPSS v. 19. RESULTS: Ovarian histopathologic findings of all three groups were significantly different in terms of hemorrhage (p<0.001), edema (p=0.001) and vascular dilatation (p< 0.001). Pathologic changes induced by I/R were reduced in ovaries of rats administered proanthocyanidin, in particular, hemorrhage, edema and vascular dilatation. CONCLUSION: Proanthocyanidin, known as free radical scavenger and antioxidant, is protective against tissue damage induced by ischemia and/or ischemia/reperfusion in rat ovaries.

Successful treatment with eculizumab in a patient with pregnancy-associated atypical hemolytic uremic syndrome.

Pregnancy-associated atypical haemolytic uraemic syndrome is a rare and potentially lethal complement-mediated disorder. It can mimic preeclampsia, gestational hypertension, thrombotic thrombocytopenic purpura and hemolysis, elevated liver enzymes and low platelets syndrome. Thus, it can be hard to distinguish pregnancy-associated atypical haemolytic uraemic syndrome from other causes in peri/post-partum women presenting with features of microangiopathic haemolytic anemia, thrombocytopenia and acute kidney injury. We present a case of a 35-year-old woman in her third pregnancy at 32 weeks' gestation who underwent caesarean section due to fetal distress. She developed severe renal impairment, thrombocytopenia and neurologic symptoms within 24 hours after delivery. A diagnosis of pregnancy-associated atypical haemolytic uraemic syndrome was provided, and treatment with plasma therapy followed by eculizumab was initiated. A rapid improvement of both clinical and laboratory parameters was observed. This case demonstrates the significance of early initiation of anti-complement therapy to prevent irreversible renal damage and possible death in women with pregnancy-associated atypical haemolytic uraemic syndrome.

Asystole after the first dose of ceftriaxone.

The incidence of ceftriaxone-related hypersensitivity skin reactions is between 1% and 3%, whereas anaphylaxis is rare. To the best of our knowledge, the following case is the first report of asystole after the administration of single-dose ceftriaxone. A 55-year-old man was admitted to our emergency department because of high fever, abdominal pain, dysuria, and weakness. To determine the cause of his fever, blood and urine cultures were obtained. Then, an infusion of 1 g ceftriaxone was started slowly. One minute later, cardiac arrest occurred. The rhythm was asystole. Cardiopulmonary resuscitation and tracheal intubation were performed immediately, and the ceftriaxone infusion was discontinued. Within 20 minutes, circulation was restored. The time of onset was suggestive of ceftriaxone-induced anaphylaxis. The patient was discharged in good clinical condition on the 10th day of admission. Emergency physicians should be mindful of the possibility of anaphylaxis and asystole that could occur with the first dose of ceftriaxone and should also make sure to offer receiving detailed informed patient consent, too.

Anaesthesiologist's Attitude and Behavior Toward Postoperative Pain Management in Turkey.

OBJECTIVE: This study aims to evaluate the approach of anaesthesiologist in Turkey and their applications toward postoperative pain treatment and in addition to raise awareness in this regard. METHODS: The target audience of this descriptive survey study was physician members of the Turkish Society of Anaesthesiology and Reanimation, who were volunteering/accepting to participate in the study. The doctors were contacted via their e-mail addresses. Data were collected online, between October 10, 2016, and November 30, 2016, using a web-based (SurveyMonkey®, https://tr.surveymonkey.com/) questionnaire form, and the data were analyzed by the Statistical Package for the Social Sciences (SPSS) version 20 software (IBM Corp.; Armonk, NY, USA). Descriptive data were presented with frequency, percentage, mean, standard deviation, median, minimum, and maximum values. RESULTS: A total of 315 people were included in the study. Around 34.9% anaesthesiologists had 5-10 years of professional experience and 61.9% of the anaesthesiologists stated that they routinely check the patients' pain level in the postoperative period. Multimodal analgesia is mostly preferred (25.3%) after major surgical intervention. Around 71.9% of the participants stated that they cannot find the required time for postoperative analgesia in their institution, and they associated this matter with excessive workload and lack of staff time. CONCLUSION: In this study, we found that anaesthesiologists in Turkey are doing the follow-up of patients during the postoperative period pain-wise and that they use specific pain scales. Anaesthesiologists think that postoperative pain treatment is not done effectively and time required for the pain treatment is not enough. They also stated that a separate team should be formed for postoperative pain management in the hospital. We believe that this study will raise awareness on this issue and will contribute to the creation of algorithms for postoperative pain treatment, the establishment of pain teams, and the provision of more effective and safer health services.

Investigation of proarrhythmic effect of high sugammadex doses: an experimental animal study.

BACKGROUND: Studies on higher doses of sugammadex effect on QT interval and leading arrhythmia have been limited. In this study, we aimed to investigate possible proarrhythmic effect of higher doses of sugammadex in conditions that required urgent reversal of neuromuscular blockade during general anesthesia in an experimental animal model. METHODS: It was experimental animal study. Total of 15 male New Zealand rabbits were randomly divided into three groups for low (4 mg/kg, n = 5), moderate (16 mg/kg, n = 5), and high dose of sugammadex (32 mg/kg, n = 5). All rabbits were premedicated by intramuscular ketamine 10 mg/kg, and general anesthesia was inducted by intravenous injection of 2 mg/kg of a propofol, 1 mcg/kg fentanyl, and 0.6 mg/kg rocuronium injection. Airway was provided by V-gel rabbit and connected to anesthetic device and ventilated at about 40 cycle/min and 10 ml/kg; oxygen 50% plus air 50% mixture was used with 1 MAC isoflurane to maintain anesthesia. Electrocardiographic monitorization and arterial cannulation were provided to follow-up mean arterial pressure and for arterial blood gas analyses. Intravenous sugammadex in three different doses were injected at 25th min of induction. After observing adequate respiration of all rabbits, V-gel rabbit was removed. Parameters and ECG recordings were taken basal value before induction and at the 5th, 10th, 20th, 25th, 30th, and 40th min to measure corrected QT intervals and were stored on digital media. QT interval was calculated as the time from the beginning of the Q wave to the end of the T wave. Corrected QT interval was calculated according to the Bazett's formula. Possible adverse effects were observed and recorded. RESULTS: In all three groups, there was no significant statistical difference in mean arterial blood gases parameters, arterial pressures, heart rates, and Bazett QTc values, and no serious arrhythmia was recorded. CONCLUSION: We found in animal study that low, moderate, and high doses of sugammadex did not significantly altered corrected QT intervals and did not cause any significant arrhythmia.

Efficacy and Safety of an Aerosol Box for Percutaneous Tracheostomy in Patients with COVID-19 in an Intensive Care Unit.

OBJECTIVE: To assess whether the use of an aerosol box for percutaneous tracheostomy in patients with COVID-19 can protect healthcare workers and affect the procedure-related outcomes and complications. STUDY DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: Çanakkale Onsekiz Mart University Hospital, Çanakkale, Turkey from March to August, 2020. METHODOLOGY: A retrospective evaluation of patients, who underwent percutaneous tracheostomy with an aerosol box, was conducted. Patients aged over 18 years, diagnosed with COVID-19 and requiring percutaneous tracheostomy were included. Exclusion criteria were: age under 18 years and refusal to participate in the study. Patients' age, gender, comorbidities, APACHE II scores at intensive care admission, numbers of intubated days, durations of tracheostomy opening time, and complications were recorded. RESULTS: Twenty-four patients underwent the procedure. Tracheostomy was performed successfully in all 24 cases (100%). The mean age of the cases was 67.2 ± 10.1 years. Four patients experienced minor bleeding related to performing the percutaneous tracheostomy using the aerosol box. No healthcare workers were infected with SARS-CoV-2 while performing the tracheostomy procedure. CONCLUSION: Use of the aerosol box had adequate efficacy and safety for performance of the percutaneous tracheostomy procedure in intubated patients with COVID-19, who were being followed up in the intensive care unit. This procedure could be used as an alternative to traditional tracheostomy methods in patients with contagious respiratory infections. Key Words: Tracheostomy, Intensive care unit, COVID-19, Aerosol box.

Evaluation of knowledge and attitudes among intensive care physicians during the COVID-19 pandemic: a cross-sectional survey.

BACKGROUND: The novel coronavirus (COVID-19) emerged in Wuhan, China, in December 2019. OBJECTIVES: To evaluate the knowledge of intensive care physicians in Turkey about COVID-19 and their attitudes towards the strategies and application methods to be used for COVID-19 cases that need to be followed up in an intensive care unit, and to raise awareness about this issue. DESIGN AND SETTING: The population for this descriptive study comprised clinicians working in a variety of healthcare organizations in Turkey who provide monitoring and treatment within the intensive care process for COVID-19 patients. METHODS: Data were collected online using a survey form on the SurveyMonkey website between April 20 and April 25, 2020. RESULTS: The mean age of the 248 intensive care clinicians participating in the study was 37.2 ± 13.7 years and 49.19% were female. High rates of classical laryngoscope use were observed, especially among clinicians employed in state hospitals. Among all the participants, 54.8% stated that they were undecided about corticosteroid treatment for patients who had been intubated due to COVID-19. CONCLUSIONS: Many medications and methods are used for COVID-19 treatment. All national science committees are attempting to create standard treatment protocols. For intensive care treatment of COVID-19 patients, many factors require management, and clinicians' experience is guiding future processes. We believe that this study will create awareness about this topic and contribute to the creation of standard treatment algorithms and the provision of better and safer healthcare services for this patient group.

Prevention of rocuronium induced mast cell activation with prophylactic oleuropein rich diet in anesthetized rabbits1.

PURPOSE: The effect of a prophylactic oleuropein-rich diet before anesthesia accompanied by the widely-used steroid-based neuromuscular drug rocuronium on mast cell activation was investigated in the study. METHODS: 14 rabbits used in the study. The rabbits in the oleuropein group were given oleuropein-rich extract added to the animals' water at doses of 20 mg/kg oleuropein for 15 days orally. After 15 days, all rabbits in the two groups were given general anesthesia with rocuronium of 1 mg/kg. After 1 day, animals were sacrificed and the liver tissue sections stained with H&E, toluidine blue and tryptase for immunohistochemical study. RESULTS: There was no statistically significant difference between ALT, AST and albumin averages of the oleuropein and control groups (p> 0.05). The tryptase average of the control group was higher than the tryptase average of the oleuropein group and this difference was statistically significant (p=0.003). The T. blue average in the oleuropein group was higher than the control group. However, there was no statistically significant difference between groups (p=0.482). CONCLUSIONS: Rocuronium adverse effects, like hypersensitivity and anaphylaxis, may limit routine use of this substance. The use of oleuropein reduced the number of inflammatory cells and prevented degranulation.

An experimental study of ascorbic acid effects in acute renal failure under general anesthesia.

PURPOSE: To evaluate the preventive effect of ascorbic acid on sevoflurane-induced acute renal failure in an experimental rat model. METHODS: Twenty-four adult male Wistar rats were randomly distributed into three groups. Subjects were allocated into 3 groups: Group I received sevoflurane only, whereas Groups II and III had moderate (150 mg/kg) and high (300 mg/kg) doses of AA in addition to sevoflurane, respectively. Rhabdomyolysis and myohemoglobinuric ARF was formed by intramuscular administration of glycerol on the upper hind limb on the 15th minute of inhalation anesthesia. Biochemical parameters consisted of serum levels of blood urea nitrogen, creatinine, neutrophil gelatinase-associated lipocalin (NGAL), total antioxidant capacity (TAC), and protein carbonyl content. Histopathological variables were tubular necrosis, fibrin, and cast formation. RESULTS: NGAL levels were significantly lower in Group III than Group II and Group I. On the other hand, TAC, PCO, urea and creatinine levels were notably higher in Group I compared with Groups II and III. There was a significant difference between 3 groups on frequencies of acute tubular necrosis (p=0.003), fibrin (p<0.001) and cast (p<0.001). Acute tubular necrosis and fibrin formation were more prominent in Group I. Casts were more common in Groups II and III. CONCLUSIONS: The ascorbic acid serve as a prophylactic agent against renal damage in patients receiving sevoflurane anesthesia and higher doses were associated with more apparent protective effects.

Protective effects of ursodeoxycholic acid in experimental corrosive esophagitis injury in rats.

Accidental caustic ingestions are serious medical problems especially in childhood. Various treatment modalities are being used for the complications of caustic injuries such as stricture formation. The aim of this study is to establish whether ursodeoxycholic acid (UDCA) has protective effects on experimental corrosive esophagitis in rats. Twenty four Wistar-albino rats, weighing 220-240 g, were used in the study. Experimental animals were divided in three groups randomly: UDCA treatment group (Group T, n:8), control group (Group K, n: 8) and sham group (Group S, n: 8). In group T and S corrosive esophagitis was induced. UDCA (5 mg/kg) was performed to the group T for 10 days orally. All animals were sacrificed at the end of procedures and histopathological changes in esophageal tissue were scored by a single investigator who was blind to the groups. In group T inflammation was present in two rats, muscularis mucosa injury in two rats, grade 1 collagen deposition in six rats and grade 2 in two rats. In comparison with group S these were statistically significant (p value was 0.003, 0.003 and 0.015, respectively). UDCA has protective effect in experimental corrosive esophagitis. KEY WORDS: Corrosive esophagitis, Rat, Stricture, Ursodeoxycholic acid.

Prevention of intraocular pressure elevation with oleuropein rich diet in rabbits, during the general anaesthesia.

BACKGROUND: Oleuropein is known to have anti-oxidant and anti-inflammatory effects. An important aim of anesthetic management in ocular surgery is to keep the intraocular pressure under control. Studies have researched a variety of prophylactic materials used to prevent increases in intraocular pressure. We aimed to research the effects of oleuropein on intraocular pressure (IOP) during general anaesthesia. METHODS: Fourteen New Zealand rabbits were randomly divided into two groups of seven. The rabbits in Group O were given olive leaf extract (OLE) equivalent to a daily dose of 20 mg/kg oleuropein for 15 days. HPLC method used for oleuropein standardization. For anaesthesia induction 1 mg/kg rocuronium was given and after muscle relaxation all animals had a V-gel Rabbit inserted. Anesthetic maintenance was provided by 1 MAC isoflurane. Twenty minutes after rabbits were given 10 mg/kg ketamine, basal IOP values were measured. After the V-gel rabbit was inserted, in the 5th, 10th, 20th, 25th and 30th minutes measurements were repeated. RESULTS: IOP data variation of OLE group was compared with control group and the measured levels were lower in Group O during the anaesthesia. IOP was 33.8 ± 4 mmHg in Group C and 24.1 ± 8 mmHg in Group O in 25th minute and the difference between the two groups was statistically significant at this time. CONCLUSION: We observed that consumption of prophylactic OLE had a reducing effect on IOP in the period before waking in anaesthesia. We believe it is necessary to investigate the effects of OLE on IOP in broad participation patient groups.

Correlation of ischemia-modified albumin levels and histopathologic findings in experimental ovarian torsion.

OBJECTIVES: Ischemia modified albumin (IMA) levels significantly increased and may be used as a diagnostic marker in ovarian torsion. The aim of this study is to investigate whether there was any correlation between IMA levels and histopathologic changes in experimental ovarian torsion. MATERIAL AND METHODS: Fourteen Sprague-Dawley rats, each weighing 220-250 g were divided randomly into 2 groups; in Group 1, the control group (n = 7), only laparotomy was performed and in Group 2, the experimental group (n = 7), ovarian torsion was performed. Ischemia was performed for 3 h; following the ischemia period, the torsion was relieved by detwisting the adnexa and then the ovarian I/R protocol was applied for 3 h. Blood samples were taken from all of the rats to measure the IMA levels and the ovaries were surgically removed for histologic examination. A blinded pathologist examined and scored the samples. RESULTS: The median (minimum-maximum) IMA values were 921.00 (870.00-966.00) ABSUs in the ovarian torsion group and 853.00 (782.00-869.00) ABSUs in the control group. The difference was statistically significant. In the correlation analysis, a significant and strong correlation was found between IMA levels and histopathologic changes (Spearman's rho = +0.987, p < 0.001). CONCLUSION: Positive correlation was found between the IMA levels and the histopathologic severity of the disease. This finding is important for both diagnosis of the disease and patient follow-up. As a new marker in ovarian torsion, IMA may also indicate the severity of the ovarian histopathology.

Evaluation of the Approaches of the Anaesthesiologists on Maintenance of Anaesthesia Machines.

OBJECTIVE: In this study, we aimed to discuss the level of knowledge and approach on 'maintenance, calibration and cleaning of anaesthesia devices' among anaesthesiologists in Turkey. METHODS: A questionnaire was prepared with 21 questions based on the Google document system, and these questionnaires were sent to the anaesthesiologists via e-mail. RESULTS: Overall, 226 anaesthesiologists answered our survey. With respect to the maintenance and calibration, anaesthesiologists had sufficient information about the vaporizer and the carbon dioxide canister devices; however, information about the vital components, such as disassembly of the anaesthesia machine, flow sensor, oxygen sensor, battery and exhaust system, was insufficient. The cleaning and sterilization procedures were performed when the devices became dirty, and the bacteria filter was used only for the protection of the anaesthesia system. There was a lack of knowledge about how and which part of the anaesthesia device should be disinfected. In total, 85% of the survey participants were thinking of the need of additional education on anaesthesia machine maintenance. CONCLUSION: It is observed that education about anaesthesia device maintenance, calibration and cleaning issues is obviously necessary for the anaesthesiology specialists in our country. We believe that it would be useful to highlight this issue to anaesthesia educational institutions and anaesthesia associations.

The acute effects of preoperative ozone theraphy on surgical wound healing.

PURPOSE: To investigate the effects of preoperative rectal ozone insufflation on surgical wound healing over the proinflammatory cytokines and histopathological changes. METHODS: Twenty one rabbits were divided into 3 groups. Sham, surgical wound, and ozone applied (6 sessions, every other day 70 µg/mL in 12 mL O2-O3 mixture rectally) surgical wound groups were created. TNF-alpha and IL-6 levels from all rabbits were studied at the basal, 24th hour, and 72nd hour. The histopathological examination was done by removing the surgical scar tissue at the end of 72nd hour. RESULTS: TNF-alfa and IL-6 levels were significantly lower compared to the control group, in the rabbits treated with ozone. The increase in angiogenesis, the decrease in the number of inflammatory cells, epidermal and dermal regeneration, better collagen deposition, and increased keratinisation in stratum corneum were observed in the histopathological examination. It was determined that the wound healing noticeably accelerated in the ozone group. CONCLUSION: Preoperative rectal ozone insufflation had a positive effect on surgical wound healing in acute period.

Evaluation of knowledge and attitudes among intensive care physicians during the COVID-19 pandemic: a cross-sectional survey

ABSTRACT BACKGROUND: The novel coronavirus (COVID-19) emerged in Wuhan, China, in December 2019. OBJECTIVES: To evaluate the knowledge of intensive care physicians in Turkey about COVID-19 and their attitudes towards the strategies and application methods to be used for COVID-19 cases that need to be followed up in an intensive care unit, and to raise awareness about this issue. DESIGN AND SETTING: The population for this descriptive study comprised clinicians working in a variety of healthcare organizations in Turkey who provide monitoring and treatment within the intensive care process for COVID-19 patients. METHODS: Data were collected online using a survey form on the SurveyMonkey website between April 20 and April 25, 2020. RESULTS: The mean age of the 248 intensive care clinicians participating in the study was 37.2 ± 13.7 years and 49.19% were female. High rates of classical laryngoscope use were observed, especially among clinicians employed in state hospitals. Among all the participants, 54.8% stated that they were undecided about corticosteroid treatment for patients who had been intubated due to COVID-19. CONCLUSIONS: Many medications and methods are used for COVID-19 treatment. All national science committees are attempting to create standard treatment protocols. For intensive care treatment of COVID-19 patients, many factors require management, and clinicians' experience is guiding future processes. We believe that this study will create awareness about this topic and contribute to the creation of standard treatment algorithms and the provision of better and safer healthcare services for this patient group.

[Comparison of the effectivity of oral and intra-articular administration of tenoxicam in patients with knee osteoarthritis]. / Comparação da eficácia de tenoxicam administrado por via oral e intra-articular a pacientes com osteoartrite de joelhos.

BACKGROUND AND OBJECTIVES: Tenoxicam is widely used in osteoarthritis treatment and we aimed to compare the effectivity of oral and intra-articular administration of tenoxicam in osteoarthritis treatment. METHODS: This study was performed between 2011 and 2012 by retrospectively analyzing and comparing the findings of 60 patients who were clinically and radiologically diagnosed with knee degenerative osteoarthritis in Bünyan state hospital pain policlinic. 60 patients included in the study were divided into two groups. The first group (tenoxicam IA, n=30) included patient findings of those subjected to intra-articular injection of 20mg tenoxicam to the knee once a week for three weeks and the second group (oral tenoxicam, n=30) included patients who were administered 20mg oral tenoxicam once a day for three weeks. All patients were clinically evaluated pre-treatment and in the 1st week, 1st month and 3rd month post-treatment according to specified criteria. RESULTS AND CONCLUSIONS: 22 of 60 patients included in the study were male and 38 were female. In both groups significant improvements were detected in all of the observed parameters: visual analog scale, Western Ontario McMaster Osteoarthritis Index (pain, physical activity, knee stiffness) and Lequesne index scores and in the evaluations performed in 1st week, 1st month and 3rd month with respect to pre-treatment values. Besides, a better compliance to treatment and gastrointestinal system tolerability in tenoxicam IA group was also observed. Intra-articular tenoxicam administration could be thought as an alternative treatment method in patients with knee osteoarthritis who cannot use oral tenoxicam especially due to systemic gastrointestinal system side effects and those who have difficulties in adapting to treatment.