Inhaled nitric oxide as rescue therapy in severe ARDS cases due to COVID-19 pneumonia: a single center experience.

OBJECTIVE: Inhaled NO (iNO) has been recommended as rescue therapy in acute respiratory stress syndrome (ARDS) cases. In this study, we aimed to demonstrate the efficacy of iNO as a rescue therapy in patients with severe ARDS due to COVID-19. PATIENTS AND METHODS: This retrospective study included patients with ARDS due to COVID-19 who were treated with iNO between March 2020 and January 2022 in the intensive care unit (ICU) of Inonu University. Patients' files were reviewed retrospectively, and demographic data, APACHE II and Sequential Organ Failure Assessment (SOFA) scores, initiation day of iNO and duration of iNO treatment, length of stay in hospital/ICU, blood biochemistry values, complete blood counts, inflammatory parameters, arterial blood gas values, lactate, PaO2/FiO2 ratios, anti-inflammatory drugs and outcome were recorded. RESULTS: Data from 16 patients were reached. iNO was given at a dose of 20 ppm continuously. The mean duration of treatment with iNO was 3.5 days. All patients took the prone position except a single patient. While all patients received steroid therapy, four patients received anti-cytokine therapy, and five patients received intravenous immunoglobulin therapy. All patients were in severe ARDS with a mean PaO2/FiO2 ratio of 58 before iNO therapy. A significant increase in PaO2/FiO2 values was detected with the use of iNO (p<0.05). While three patients (19%) were discharged from the ICU, thirteen patients died. CONCLUSIONS: In our study, it was determined that iNO applied as a rescue treatment in patients with severe ARDS improved oxygenation. Although the effect of iNO on survival was low, it may be interpreted as clinically significant considering the severity of the general clinical condition of the patients.

Prognosis of hospitalized patients with community-acquired pneumonia.

INTRODUCTION: The long-term prognosis of patients with community-acquired pneumonia (CAP) has attracted increasing interest in recent years. The objective of the present study is to investigate the short and long-term outcomes in hospitalized patients with CAP and to identify the predictive factors associated with mortality. PATIENTS AND METHODS: The study was designed as a retrospective, multicenter, observational study. Hospitalized patients with CAP, as recorded in the pneumonia database of the Turkish Thoracic Society between 2011 and 2013, were included. Short-term mortality was defined as 30-day mortality and long-term mortality was assessed from those who survived 30 days. Predictive factors for short- and long-term mortality were analyzed. RESULTS: The study included 785 patients, 68% of whom were male and the mean age was 67±16 (18-92). The median duration of follow-up was 61.2±11.8 (37-90) months. Thirty-day mortality was 9.2% and the median survival of patients surviving 30 days was 62.8±4.4 months. Multivariate analysis revealed that advanced age, the absence of fever, a higher Charlson comorbidity score, higher blood urea nitrogen (BUN)/albumin ratios and lower alanine aminotransferase (ALT) levels were all predictors of long-term mortality. CONCLUSION: Long-term mortality following hospitalization for CAP is high. Charlson score and lack of fever are potential indicators for decreased long-term survival. As novel parameters, baseline BUN/albumin ratios and ALT levels are significantly associated with late mortality. Further interventions and closer monitoring are necessary for such subgroups of patients.

What is the neutrophil/lymphocyte ratio in sarcoidosis?

AIM: Information regarding the Neutrophil/Lymphocyte ratio (NLR) in sarcoidosis and the data from studies recommending its use as an indicator of inflammation and in the differential diagnosis and prognosis, are limited. With this study, it was aimed to obtain data regarding the NLR level in the patients at the time of presentation to the hospital and to determine the characteristics of patients in whom the NLR value was > 2. RESULTS: During the study period, of the 3434 patients with the sub-diagnosis of D86, 1300 cases whose complete blood count values had been recorded at the time of presentation were included in the study. Of the cases, 40 % were pulmonary sarcoidosis, 7 % were pulmonary sarcoidosis with sarcoidosis of the lymph nodes, 8 % were lymph node sarcoidosis, 1 % were sarcoidosis, of other combined areas, and 40 % of the cases were sarcoidosis that were unspecified. The F/M of the cases were 947/353, and the average age of the cases was 44. When the sarcoidosis groups were grouped into NLR < 2 (Group 1) and NLR ≥ 2 (Gorup 2), 27 % were Group 1, 73 % were Group 2, and a significant correlation was found between the two groups. When the inflammatory indicators were compared with NLR, the PLT/MPV was found to be statistically insignificant, and the ACE, ESR and CRP were found to be statistically significant. CONCLUSION: The Neutrophil/Lymphocyte ratio in the complete blood count, which is an easy and cheap test, can be used as an indicator of inflammation in Sarcoidosis. In clinical practice, wide-based studies comprising the activity and the staging in the prognosis of sarcoidosis are required (Tab. 2, Fig. 2, Ref. 26).