Comparison of Optic Nerve Sheath Diameters Measured by Optic Ultrasonography Before and After Lumbar Puncture in Idiopathic Intracranial Hypertension Patients.

Introduction: Idiopathic intracranial hypertension (IIH) symptoms include headache, blurred vision, and papilledema which may lead to permanent vision loss unless diagnosed and treated. Definitive diagnosis of IIH usually requires the measurement of intracranial pressure (ICP) via lumbar puncture (LP) which is an invasive and unwanted technique for patients. In our study, optic nerve sheath diameters (ONSD) were measured before and after lumbar puncture in IIH patients and the relationship of these measurements with ICP changes was evaluated as well as the effect of decreasing cerebrospinal fluid (CSF) pressure after a lumbar puncture on ONSD. Thus, we want to investigate whether optic nerve ultrasonography (USG) is a useful tool instead of the invasive LP for the diagnosis of IIH. Methods: A total of 25 patients who applied to the neurology clinics of Ankara Numune Training and Research Hospital between May 2014 and December 2015 and were diagnosed with IIH were included in the study. The control group consisted of 22 individuals who applied with complaints other than headaches, visual impairment or tinnitus. Optic nerve sheath diameters were measured from both eyes before and after the LP. After pre-LP measurements were taken, opening and closing CSF pressure was measured. In the control group, ONSD was measured with optic USG. Results: Mean age of the IIH group and the control group was determined as 34.8±11.5 and 45.8±13.3 years, respectively. In the patient group, mean CSF opening pressure was 33.9±8.0 cm H2O and mean closing pressure was 18.1±4.7 cm H2O. Mean ONSD measured pre-LP was 7.1±1.0 mm in the right eye and 6.9±0.7 mm in the left eye, while mean post-LP ONSD was 6.7±0.9 mm in the right eye and 6.4±0.8 mm in the left eye. There was a statistically significant difference between ONSD values before and after the LP (p=0.006 for the right eye, p<0.001 for the left eye). In the control group, mean ONSD was 5.4±0.7 mm in the right eye and 5.5±0.6 mm in the left eye, and a statistically significant difference was found between ONSD values before and after the LP (p<0.001 for the right eye and left eye). A significant positive correlation was determined between left ONSD measurements before the LP and CSF opening pressure (r=0.501, p=0.011). Conclusions: In the present study, it was found that ONSD measurement by optic USG significantly displays increased ICP, and decreasing pressure via LP is rapidly reflecting ONSD measurement. Based on these findings, it is suggested that ONSD measurements by optic USG, a non-invasive method, can be used in the diagnosis and follow-up of IIH patients.

COVID-19 phobia in healthcare workers; a cross-sectional study from a pandemic hospital.

INTRODUCTION: Healthcare workers (HCWs) are at the forefront of the fight against coronavirus. The purpose of this study was to evaluate COVID-19 phobia levels of HCWs of a pandemic hospital and explore associated factors. MATERIALS AND METHODS: This was a descriptive cross-sectional study conducted on HCWs employed in a pandemic hospital. A total of 365 HCWs (95 physicians, 187 nurses and 83 assistant healthcare staffs) were included in the study. In order to evaluate COVID-19 phobia, coronavirus-19 phobia scale (C19P-S) was administrated. Chronophobia levels of frontline and nonfrontline HCWs were compared. Additionally, the effect of working in different departments, profession and associated factors on COVID-19 phobia was evaluated. RESULT: Overall, 172 HCWs completed the C19P-S and agreed to participate in the study. Mean total CP19P-S score of the HCWs included in the study was 50.1 ± 17.3. Of the study population, 59.3% participants were frontline HCWs and 40.7% were non-frontline HCWs. When frontline HCWs and nonfrontline HCWs were compared in terms of total C19P-S and subscales scores (psychological, psycho-somatic, economic, social), no statistically significant differences were found (p= 0.914, p= 0.687, p= 0.766, p= 0.347, p= 0.794, respectively).When the HCWs were divided into three groups according to departments (clinics, intensive care unit (ICU), emergency department) where they worked regardless of whether they cared for patients with COVID-19, HCWs employed in the ICUs had the highest scores regarding total C19P-S and subscales scores (p= 0.002, p= 0.001, p= 0.001, p= 0.012, p= 0.002,respectively) . Profession based comparison revealed no significant difference between the groups regarding total C19P-S score (p= 0.117). CONCLUSIONS: It is essential to make a comprehensive evaluation regarding the effects of pandemics on HCWs, not only for controlling the COVID-19 pandemic but also to protect the mental health of HCWs. Critical care professions appear to need particular attention among HCWs. The C19P-S, which assesses coronaphobia levels with psychological, psycho-somatic, economic, and social aspects could be a convenient screening tool for evaluating COVID-19 phobia levels in HWCs.

The effect of driving pressures in COVID-19 ARDS: Lower may still be better as in classic ARDS.

BACKGROUND: The respiratory dynamics of coronavirus disease 2019 (COVID-19) patients under invasive ventilation are still not well known. In this prospective cohort, we aimed to assess the characteristics of the respiratory system in COVID-19 patients under invasive mechanical ventilation and evaluate their relationship with mortality. METHODS: Fifty-eight COVID-19 patients who underwent invasive mechanical ventilation between March 11, 2020 and September 1, 2020 were enrolled for the present study. Demographics and laboratory values at baseline were recorded. Respiratory variables such as tidal volume, plateau pressure, positive end expiratory pressure, static compliance, and driving pressure were recorded daily under passive conditions. Further, the median values were analyzed. RESULTS: Median age of the patients was 64 years (58-72). Mortality was 60% on day 28. Plateau pressure, driving pressure, and static compliance significantly differ between the survivors and non-survivors. When patients were categorized into two groups based on the median driving pressure (Pdrive) of ≤15 cmH2O or >15 cmH2O during their invasive mechanical ventilation period, there was significantly better survival on day 28 in patients having a Pdrive ≤ 15 cmH2O [28 days (95% CI = 19-28) vs 16 days (95% CI = 6-25), (log-rank p = 0.026). CONCLUSION: COVID-19 related acute respiratory distress syndrome (ARDS) seemed to have similar characteristics as other forms of ARDS. Lung protective ventilation with low plateau and driving pressures might be related to lower mortality.