Can Pneumothorax Developing in COVID-19 Patients be a Mortality Marker?

Objectives: The purpose of this study is to investigate the effects of pneumothorax (PX), a rare complication of COVID-19, on mortality. Methods: All patients admitted to our hospital with the diagnosis of COVID-19 were screened, and patients who developed PX were included in the study. Patient demographics data, number of days of hospitalization for comorbidities, day and duration of thorax tube insertion, and laboratory findings during hospitalization were recorded by scanning the hospital automation system and patient records. Results: For our study, 7485 patients hospitalized with the diagnosis of COVID-19 were screened in intensive care unit. PX was detected in 32 (0.296%) of the patients. About 59.4% of these patients included in the study were male. DM was the most common comorbid condition at 56.3%. In these patients, the mortality rate was found to be 90.6%. Conclusion: The data obtained indicate that PX, a COVID-19 complication, leads to a serious increase in mortality. We believe that using protective ventilation methods to avoid the development of pneumotarax will help to reduce mortality. Keywords: COVID-19, mortality, pneumothorax (English) [ FROM AUTHOR]

Evaluation of neurological disorders that develop concurrently with COVID-19 pneumonia: a retrospective analysis.

BACKGROUND: During the pandemic, many neurological symptoms have been evaluated as complications of COVID-19 pneumonia. OBJECTIVE: To investigate the frequency and characteristics of neurological findings, and their effects on the prognosis of patients with COVID-19 pneumonia who consulted with the Neurology department. METHODS: Data on 2329 patients who were hospitalized with the diagnosis of COVID-19 pneumonia in our hospital were scanned. The clinical, laboratory and radiological findings relating to treatment of 154 patients who required neurological consultation were retrospectively evaluated by reviewing the clinical notes. RESULTS: The number of COVID-19 pneumonia patients who required neurological consultations while hospitalized in the ICU was 94 (61.0%). The most common symptom among these patients was hyperactive delirium. Mean age, ferritin levels and CRP values ​​of those with delirium were higher, while the mean lymphocyte percentage were lower, than those of the patients without delirium. Epileptic seizures were observed in eight patients without an epilepsy diagnosis. Two patients were diagnosed with GBS and one patient with ICU neuropathy. The D-dimer levels of patients with acute hemorrhagic CVD and the thrombocyte levels of patients with acute ischemic CVD were found to be higher than in patients without acute ischemic CVD. CONCLUSION: The proportion of patients who required neurological consultations was higher in the ICUs. We observed neurological symptoms more frequently in the advanced age group. There were no significant increases in the incidence of other neurological conditions except delirium, in COVID-19 patients. We think that further studies are needed to support our data.

Comparison of nutritional risk status assessment tools in predicting 30-day survival in critically ill COVID-19 pneumonia patients.

BACKGROUND: Few clinical studies have addressed nutritional risk assessment in patients with COVID-19 pneumonia admitted to the intensive care unit (ICU). OBJECTIVES: Assess the nutritional risk status of the critically ill COVID-19 pneumonia patients admitted to the ICU, and compare the nutritional risk screening tools. DESIGN: Medical record review SETTING: Tertiary critical care unit PATIENTS AND METHODS: We included adult (age >18 years) PCR-confirmed critically ill COVID-19 pneumonia cases admitted to the ICU between August 2020 and September 2021. Scoring systems were used to assess COVID-19 severity and nutritional status (mNUTRIC: modified Nutrition Risk in Critically Ill, NRS2002: Nutritional Risk Screening 2002). The 30-day mortality prediction performance of nutritional scores and survival comparisons between clinical and demographic factors were assessed. MAIN OUTCOME MEASURES: Compare the nutrition risk tools SAMPLE SIZE: 281 patients with a mean (SD) age of 64.3 (13.3) years; 143 (50.8%) were 65 years and older. RESULTS: The mean mNUTRIC score of the cases was 3.81 (1.66) and the mean NRS-2002 score was 3.21 (0.84.), and 101 (35.9%) were at high risk of malnutrition according to the mNUTRIC score and 229 (81.4%) according to the NRS 2002 score. In cases at high risk of malnutrition by the mNUTRIC score there was a greater need for invasive mechanical ventilation, vasopressors, and renal replacement therapy (P<.001 for all comparisons). The mNUTRIC score was superior to the NRS-2002 score in estimating 30-day mortality. In patients who died within 30 days, the mNUTRIC score and NRS-2002 score on the day of hospitalization were significantly higher (P<.001), and the proportion of patients with NRS-2002 score ≥3 and mNUTRIC score ≥5 was significantly higher in the non-surviving group (P<.001). In addition, patients with a high risk of malnutrition had a shorter survival time. The mNUTRIC score was an independent and important prognostic factor for 30-day mortality, and patients with an mNUTRIC score ≥5 had a 6.26-fold risk for 30-day mortality in the multivariate Cox regression. CONCLUSION: One third of critical COVID-19 pneumonia cases hospitalized in the ICU due to acute respiratory failure have a high risk of malnutrition, and a high mNUTRIC score is associated with increased mortality. LIMITATIONS: Single center retrospective study. CONFLICT OF INTEREST: None.

Sinovac vaccination and the course of COVID-19 disease in hospitalized patients in Turkey.

BACKGROUND: The Alpha variant of SARS-CoV-2 has a higher transmission rate than the first variant identified. The efficacy of vaccines is affected by the characteristics of SARS-CoV-2 variants. OBJECTIVE: Investigate the relationship of vaccination and virus variant on the course of the disease in patients who were hospitalized with a diagnosis of COVID-19. DESIGN: Retrospective, cohort study SETTING: Tertiary health institution PATIENTS AND METHODS: The study included patients older than the age of 18 years who were hospitalized in a COVID-19 service or the intensive care unit with a diagnosis of COVID-19 between 1 January 2021 and 30 April 2021. Demographic characteristics, vaccination and the Alpha virus variant status, comorbidities, and information about hospitalization were obtained from the hospital automation system and patient files. MAIN OUTCOME MEASURES: Vaccination rate and relationship with course of disease. SAMPLE SIZE: 608 RESULTS: Most of the patients (n=482, 79.3%) were admitted to the COVID-19 service. More of the COVID-19 service patients had the Alpha variant than the patients admitted to ICU (P<.009). The Alpha variant was also more common in younger patients (P<.001). There was no relationship between the Alpha virus and comorbid diseases such as diabetes mellitus and hypertension. Mortality was lower in the patients who had received a second dose of the Sinovac vaccine (P=.004) compared with unvaccinated patients. CONCLUSION: Although the Alpha variant spreads faster, it has a milder course. If only the Sinovac vaccine is available, we recommend that the two doses of the Sinovac vaccine be administered. LIMITATIONS: Our study is single-center and did not include pregnant and pediatric patients. CONFLICT OF INTEREST: None.

Kritik COVID-19 Pnömonisi Olgularında Nütrisyon Risk Durumunun Değerlendirmesi ve Modifiye NUTRIC Skorun 30 Günlük Sağkalım Üzerindeki Etkisi

Amaç: Yoğun bakım ünitesine (YBÜ) kabul edilen koronavirüs hastalığı-19 (COVID-19) pnömonisi olgularında nütrisyon risk değerlendirmesi ile ilgili sınırlı sayıda klinik çalışma bulunmaktadır. Bu çalışmanın amacı COVID19 pnömonisi nedeni ile akut solunum yetmezliği gelişen ve YBÜ’ye kabul edilen kritik COVID-19 pnömonisi olgularının nütrisyon risk durumununun değerlendirilmesi ve mNUTRIC skorun 30 günlük sağkalım ile ilişkisinin araştırılmasıdır. Gereç ve Yöntem: Bu çalışma Ağustos 2020 ve Eylül 2021 tarihleri arasında Malatya Eğitim ve Araştırma Hastanesi COVID-19 YBÜ’de tedavi görmüş 18 yaş üzerindeki kritik COVID-19 pnömonisi olgularında retrospektif kohort olarak gerçekleştirilmiştir. Çalışmaya 48 saatten daha uzun süre YBÜ’de takip ve tedavi edilen toplam 281 kritik COVID-19 pnömonisi olguları dahil edilmiştir (Şekil 1). Bulgular: Olguların 167’si (%59,4) erkek ve 114’ü (%40,6) kadın olup ortalama yaş 64,3±13,3 yıl idi. Olguların 143’ünü (%50,8) 65 yaş ve üzerindekiler oluşturmaktaydı. Olguların mNUTRIC skoru 3,81±1,66 ve NRS-2002 skoru ise 3,21±0,84 olarak saptanmıştır. mNUTRIC skoruna göre olguların 101’inin (%35,9), NRS-2002 skoruna göre ise 229’unun (%81,4) malnütrisyon riski açısından yüksek riskli oldukları saptanmıştır. Malnütrisyon riski yüksek olan olgularda daha fazla invaziv mekanik ventilasyon, vazopresör ve renal replasman tedavisi gereksiniminin geliştiği saptanmıştır (p<0,001). Otuz günlük mortalite tahmininde mNUTRIC skorunun NRS-2002 skorundan daha üstün olduğu saptanmıştır (Şekil 2). Otuz gün içinde ölen olgularda YBÜ yatış günü mNUTRIC skoru ve NRS-2002 skoru anlamlı olarak yüksek bulunmuştur (p<0,001) ve NRS-2002 skoru ≥3 ve mNUTRIC skoru ≥5 olan hastaların oranı hayatta kalmayan grupta anlamlı olarak daha yüksek bulunmuştur (p<0,001). Ek olarak malnütrisyon riski yüksek olan olguların sağkalım sürelerinin daha kısa olduğu mNUTRIC skorunun 30-günlük mortalite için bağımsız ve önemli bir prognostik faktör olduğu ve mNUTRIC skoru ≥5 olan olguların 30 günlük mortalite açısından 6,26 kat riske sahip oldukları saptanmıştır (Tablo 1). Sonuç: Akut solunum yetmezliği nedeni ile YBÜ’ye kabul edilen kritik COVID-19 pnömonisi olgularının üçte biri yüksek malnütrisyon riskine sahip olup yüksek mNUTRIC skoru artmış mortalite ile ilişkilidir. (Turkish) [ FROM AUTHOR] Copyright of Turkish Journal of Intensive Care is the property of Galenos Yayinevi Tic. LTD. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Yoğun Bakımda Yatan COVID Pnömonili Hastaların Aşılanma Durumu ile Mortalite ilişkisi

Amaç: SARS-CoV-2’nin neden olduğu yeni koronavirüs hastalığı Mart 2021’den beri ülkemizi etkisi altına almıştır. Bir çok ülkede ivedi şekilde aşı çalışmalarına başlanmış;faz 1, 2, 3 çalışmaları tamamlanmış, ülkemizde Ocak 2021 itibarı ile aşılama startı verilmiştir. Biz bu çalışmamızda ilimizde yaşanan 4. dalgada yoğun bakımda yatan COVID pnömonili olguların aşılanma durumlarının mortaliteye etkisini karşılaştırmayı amaçladık. Gereç ve Yöntem: 1 Temmuz 2021-15 Aralık 2021 tarihleri arasında COVID-19 pnömoni tanısı ile yoğun bakım ünitesinde yatırılan 18 yaş ve üstü hastalar retrospektif olarak incelendi. Hastaların yaş, cinsiyet, yatış esnasındaki aşılanma durumu, yandaş hastalıkları, yatış günündeki solunum desteği durumu hastane otomasyon sistemi incelenerek kayıt altına alındı. Bulgular: Çalışmaya 92’si (%66,2) kadın ve 47’si (%33,8) erkek olmak üzere toplam 139 yoğun bakım hastası dahil edilmiştir. Hastalar aşı olma durumuna göre gruplandırıldığında 81’inin (%58,3) aşısız, 41’inin (%29,5) 2 doz aşılı ve 17’sinin (%12,2) 3 doz aşılı olduğu görülmüştür. Íki doz aşılı olanların 8’i (%5,8) 2 doz BioNTech ve 33’ü (%23,7) 2 doz Sinovac aşılı olduğu görülmektedir. Aşı olma durumuna göre mortaliteleri incelendiğinde aşısız olanların %77,8’i, 2 doz aşılı olanların %82,9’u ve 3 doz aşılı olanların ise %47,1’i eksitus olmuştur. Aşı olma durumları arasında mortalite açısından anlamlı farklılık görülmüştür. Üçüncü doz aşılı olanlardan 2 Sinovac + BioNTech olanların %33,3’ü, 2 Sinovac + Sinovac olanların ise %54,5’i eksitus olmuştur. Íki doz aşı olan hastaların aşı oldukları tarih ile yoğun bakıma yatış süreleri arasında ortalama 6 ay süre geçtiği görülmüştür. Sonuç: Global olarak COVID-19 aşılarının COVID-19 pandemisini kalıcı şekilde kontrol altına almak için en etkili yaklaşım olduğuna dair güçlü bir fikir birliği vardır. Aşılama sonrasında yoğun bakıma yatış hızının azaldığı ve sağlık bakanlığının belirlediği aşılama takvimine göre hatırlatma dozunu olan hasta grubunda yoğun bakım yatışlarının belirgin oranda azaldığı görülmüştür. Sonuç olarak aşı, bugün için enfeksiyon hastalığından korunmada en etkili, en güvenli, en ekonomik ve en akılcı tıbbi bir yaklaşımdır. Pandemi döneminde hastanelerdeki iş yükünün azaltılması ve yoğun bakım ünitelerine yatışın önlenebilmesi açısından aşılamanın önemi göz ardı edilmemelidir. (Turkish) [ FROM AUTHOR] Copyright of Turkish Journal of Intensive Care is the property of Galenos Yayinevi Tic. LTD. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Peripheral Blood Smear Findings of COVID-19 Patients Provide Information about the Severity of the Disease and the Duration of Hospital Stay.

BACKGROUND: Data about the morphological changes in peripheral blood smears during COVID-19 infection and their clinical severity association are limited. We aimed to examine the characteristics of the cells detected in the pathological rate and/or appearance and whether these findings are related to the clinical course by evaluating the peripheral blood smear at the time of diagnosis in COVID-19 patients. METHODS: Clinical features, laboratory data, peripheral blood smear of fifty patients diagnosed with COVID-19 by PCR was evaluated at diagnosis. Peripheral smear samples of the patients were compared with the age and sex-matched 30 healthy controls. Pictures were taken from the patient's peripheral blood smear. Patients were divided into two groups. Mild and severe stage patient groups were compared in terms of laboratory data and peripheral smear findings. The relationship between the laboratory values of all patients and the duration of hospitalization was analyzed. RESULTS: The number of segmented neutrophils and eosinophils were low, pseudo-Pelger-Huet, pseudo-Pelger-Huet/mature lymphocyte ratio, atypical lymphocytes, monocytes with vacuoles, bands, and pyknotic neutrophils rates were higher in the peripheral blood smear of the patient group (p <0.05). Increased pseudo-Pelger-Huet anomaly, pseudo-Pelger Huet/mature lymphocyte ratio, a decreased number of mature lymphocytes, and eosinophils in peripheral blood smear were observed in the severe stage patients (p <0.05). A negative correlation was observed between hospitalization duration and mature lymphocyte and monocytes with vacuoles rates (p <0.05). CONCLUSION: A peripheral blood smear is an inexpensive, easily performed, and rapid test. Increased Pseudo-Pelger-Huet anomaly/mature lymphocyte rate suggests a severe stage disease, while high initial mature lymphocyte and monocytes with vacuoles rates at the time of diagnosis may be an indicator of shortened duration of hospitalization.