Yoğun Bakım Ünitesindeki COVID-19 Hastalarında Ímmünosüpresan Ajanların Kullanımı ve Sekonder Enfeksiyonlar: Retrospektif Çalışma

Amaç: COVID-19’da pulse metilprednizolon (PMP), deksametazon (DXM) ve interlökin blokerler (IL-B) gibi immünosüpresan ajanların kullanıldığı bilinmektedir. Bu çalışmanın amacı, yoğun bakım ünitelerindeki (YBÜ) COVID-19 hastalarında bu immünosüpresan ajanların sekonder enfeksiyonlara etkisini araştırmaktır. Gereç ve Yöntem: Çalışma retrospektif olarak tasarlandı, Mart 2020-Ekim 2021 tarihleri arasında 6 üçüncü basamak yoğun bakım ünitesindeki veriler değerlendirildi. Tüm hastalar grup I (GI, immünosüpresan ajan yok veya MP ≤1,0 mg/kg), grup II (GII, PMP ve/veya DXM) ve grup III (GIII, sadece IL-B ve PMP ve/veya DXM) olarak üç gruba ayrıldı. Demografik veriler, PaO2 /FiO2 (P/F) oranı, C-reaktif protein (CRP) ve prokalsitonin, hemogram parametreleri, ferritin ve D-dimer, kültür sonuçları ve sağkalım kaydedildi. GI-GII ve GI-GIII arasında karşılaştırma yapmak için 14 parametre için [yaş, cinsiyet, BMI, CCI, APACHE II, P/F oranı, CRP, prokalsitonin, hemogram parametreleri, ferritin, D-dimer ve invaziv mekanik ventilasyon (IMV) gereksinimleri] eğilim skoru ile (propensitiy score maching-PSM) eşleştirme yapıldı. Bulgular: Çalışmaya 412 YBÜ hastası dahil edildi (GI=118, GII=184, GIII=110). Ölüm oranları sırasıyla %27,1, %39,7 ve %55,5 idi. PSM sonrası GII ve GIII’de (+) trakeal kültür, (+) kan dolaşımı kültür sayısı, YBÜ süresince farklı mikroorganizma saptanması, nöropati, trakeotomize hasta sayısı, IMV süresi ve YBÜ’de kalış süresi GI’den anlamlı olarak yüksekti. Mortalite oranı ve (+) sitomegalovirüs (CMV) -DNA-PCR düzeyi, GI ve GII’de benzer iken, GIII’de GI’den anlamlı derecede yüksekti. Sonuç: COVID-19’da immünosüpresan ajanların kullanımı sekonder enfeksiyonların artmasına neden olur. Ayrıca, artan ikincil enfeksiyonlar uzamış yoğun bakım kalışı ve invaziv mekanik ventilasyon (IMV) süresine sebep olmakta, beraberinde mortaliteyi arttırmaktadır. (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.)

Struggle Against Pandemic in A Private Hospital: What We Have Learnt from Pandemic?

Corona Virus disease 2019 (COVID-19), which is one of the biggest outbreaks in the last century and is caused by a kind of coronavirus, spread to many countries in a short time after being first seen in the Wuhan region of China in December 2019. The COVID-19 outbreak, which spread rapidly and caused many deaths, was declared as a pandemic by the World Health Organization on March 11, 2020. The first COVID-19 case in Turkey, coincidentally, was seen on the same day. In this article, the story of the pandemic struggle successfully carried out in a private hospital and the teachings of the process are provided.

A practical approach to imaging characteristics and standardized reporting of COVID-19: a radiologic review.

Novel coronavirus (2019-nCoV), also known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is a pathogen that has caused a rapidly spreading pandemic all over the world. The primary mean of transmission is inhalation with a predilection for respiratory system involvement, especially in the distal airways. The disease that arises from this novel coronavirus is named coronavirus disease 2019 (COVID-19). COVID-19 may have a rapid and devastating course in some cases leading to severe complications and death. Radiological imaging methods have an invaluable role in diagnosis, follow-up, and treatment. In this review, radiological imaging findings of COVID-19 have been systematically reviewed based on the published literature so far. Radiologic reporting templates are also emphasized from a different point of view, considering specific distinctive patterns of involvement.

Predictive value of CT imaging findings in COVID-19 pneumonia at the time of first-screen regarding the need for hospitalization or intensive care unit.

PURPOSE: In this study, we aimed to reveal the relationship between initial lung parenchymal involvement patterns and the subsequent need for hospitalization and/or intensive care unit admission in coronavirus disease 2019 (COVID-19) positive cases. METHODS: Overall, 231 patients diagnosed with COVID-19 as proven by PCR were included in this study. Based on the duration of hospitalization, patients were divided into three groups as follows: Group 1, patients receiving outpatient treatment or requiring hospitalization <7 days; Group 2, requiring hospitalization ≥7 days; Group 3, patients requiring at least 1 day of intensive care at any time. Chest CT findings at first admission were evaluated for the following features: typical/atypical involvement of the disease, infiltration patterns (ground-glass opacities, crazy-paving pattern, consolidation), distribution and the largest diameters of the lesions, total lesion numbers, number of affected lung lobes, and affected total lung parenchyma percentages. The variability of all these findings according to the groups was analyzed statistically. RESULTS: In this study, 172 patients were in Group 1, 39 patients in Group 2, and 20 patients in Group 3. The findings obtained in this study indicated that there was no statistically significant difference in ground-glass opacity rates among the groups (p = 0.344). The rates of crazy-paving and consolidation patterns were significantly higher in Groups 2 and 3 than in Group 1 (p = 0.001, p = 0.002, respectively). The rate of right upper, left upper lobe, and right middle lobe involvements as consolidation pattern was significantly higher in Group 3 than in Group 1 (p = 0.148, p = 0.935, p = 0.143, respectively). A statistically significant difference was also found between the affected lobe numbers, total lesion numbers, the diameter of the largest lesion, and the affected lung parenchyma percentages between the groups (p = 0.001). The average number of impacted lobes in Group 1 was 2; 4 in Group 2 and Group 3. The mean percentage of affected lung parenchyma percentage was 25% in Group 1 and Group 2, and 50% in Group 3. CONCLUSION: In case of infiltration dominated by right middle or upper lobe involvement with a consolidation pattern, there is a higher risk of future intensive care need. Also, the need for intensive care increases as the number of affected lobes and percentage of affected parenchymal involvement increase.

Relationship between disease severity and serum IL-6 levels in COVID-19 anosmia.

BACKGROUND: An association between IL-6 levels and cytokine storm syndrome in COVID-19 patients has been suggested. Cases with higher IL-6 levels have more rapid progression and a higher complication rate. On the other hand, COVID-19 cases with anosmia have a milder course of the disease. OBJECTIVE: We aimed to investigate whether there is a relationship between serum IL-6 levels and presence of anosmia in COVID-19 patients. METHODS: Patients with a confirmed diagnosis of COVID-19 based on laboratory (PCR) were stratified into two groups based on presence of olfactory dysfunction (OD). In all cases with and without anosmia; psychophysical test (Sniffin' Sticks test) and a survey on olfactory symptoms were obtained. Threshold (t) - discrimination (d) - identification (i), and total (TDI) scores reflecting olfactory function were calculated. Clinical symptoms, serum IL-6 levels, other laboratory parameters, and chest computed tomography (CT) findings were recorded. RESULTS: A total of 59 patients were included, comprising 23 patients with anosmia and 36 patients without OD based on TDI scores. Patients with anosmia (41.39 ± 15.04) were significantly younger compared to cases without anosmia (52.19 ± 18.50). There was no significant difference between the groups in terms of comorbidities, smoking history, and symptoms including nasal congestion and rhinorrhea. Although serum IL-6 levels of all patients were above normal values (7 pg/mL), patients with anosmia had significantly lower serum IL-6 levels (16.72 ± 14.28 pg/mL) compared to patients without OD (60.95 ± 89.33 pg/mL) (p = 0.026). CONCLUSION: Patients with COVID-19 related anosmia tend to have significantly lower serum levels of IL-6 compared to patients without OD, and the lower IL-6 levels is related to milder course of the disease. With the effect of low cytokine storm and IL-6 level, it may be said that anosmic cases have a milder disease in COVID-19.

Brain MRI Findings in Patients in the Intensive Care Unit with COVID-19 Infection.

Online supplemental material is available for this article.