Is a guideline required to predict the intensive care unit need of patients over 65 years of age during the pre-operative period? A comparison of the American Society of Anesthesiologists, lung ultrasound score, Charlson age-added comorbidity index, surgi.

BACKGROUND: All pre-operative, intra-operative, and post-operative variables of the patients at 65 years of age who had a surgi-cal procedure determine the necessity of post-operative intensive care unit (ICU) monitoring. The indication for post-operative ICU is detected through ideal scoring systems related to the surgery and anesthesia that will be performed easily and fast would prevent the development of morbidity and mortality in high-risk patients. In the present study, we compared the efficacy of the American Society of Anesthesiologists (ASA) score, lung ultrasound score (LUSS), Charlson age-added comorbidity index (CACI), and surgical outcome risk tool (SORT) score of the indication for ICU. The hypothesis of our study is to show that real visual LUSS is superior to the screening test SORT, CACI, and the other score, ASA, for ICU indication determination. METHODS: The study enrolled 101 patients over 65 years of age who will have surgical procedures under elective conditions. De-mographic features, clinical parameters, ICU indications, ASA, LUSS, CACI, and SORTs of the patients were calculated prospectively and recorded. The effects of patients' ASA, LUSS, CACI, and SORT on determining the need for postoperative ICU admission were examined. RESULTS: The age of patients who needed post-operative ICU admission was significantly higher than those who did not need post-operative ICU admission (P<0.001). The groups did not show differences in terms of gender, body mass index, smoking, and type of anesthesia (P>0.05). ASA, LUSS, CACI, and SORT were significantly higher for patients who needed post-operative ICU admission (P<0.001). The proportion of patients who needed post-operative ICU admission was higher for patients with post-operative ICU indication (P<0.001). The number of consultations was significantly higher for patients who needed post-operative ICU admission (P<0.001). SORT was found to be the highest accuracy for predicting the need for post-operative ICU admission. CONCLUSION: It was detected that ASA, LUSS, CACI, and SORT are effective for the determination of the ICU indication in the pre-operative evaluation process of patients over the age of 65 who had elective surgery. However, the efficiency of SORT was found to be superior to the others.

Comparing elective and emergency caesarean section by using bioimpedance method.

BACKGROUND: There are limited studies focusing on hemodynamic changes between elective and emergent C/S cases. We considered that a better understanding of the alterations and physiological reactions in both situations with non-invasive novel technologies might be useful in managing maternal and fetal sides. METHODS: In this prospective observational study, non-invasive hemodynamic changes were observed by using the whole-body impedance method using the NICaS™ device. CO, cardiac index (CI), stroke volume (SV), stroke index (SI), total peripheric resistance (TPR), and cardiac reserve (GGI) parameters were evaluated with a non-invasive method. Measurements were done initiating before surgery, 9 times of 5 min intervals. RESULTS: All 95 patients finished the study. 47 cesarean sections were in the elective group, 48 were in the emergent group. SV in 4.5.6. time intervals were statistically increased in the elective group (p values: SvMl4: 0.025, SvMl5: 0.049, SvMl6: 0.044) (p < 0.05). SI in the second-time interval was statistically increased in the emergent group (p-value SI2: 0.047) (p < 0.05). SI in the 4th time interval was statistically increased in the elective group (p-value SI4: 0.047) (p < 0.05). CO measurements were not statistically different between groups in all time intervals for all comparisons. CI in the second time interval was statistically decreased in the elective group (p-value CI2: 0.012) (p < 0.05). GGI in the 4th time interval was statistically increased in the elective group (p-value GGI4: 0.035) (p < 0.05). TPRI in the second time interval was statistically increased in the elective group (p-value TPRI 2: 0.014) (p < 0.05). CONCLUSIONS: Understanding normal hemodynamic values before, during, and after C/S is feasible and might help the clinician assess patients' cardiac performance with a reliable noninvasive technique. NICaS might be a reliable tool to evaluate patients' baseline values and diagnose complications earlier during the surgery.

Performance of pneumonia severity index and CURB-65 in predicting 30-day mortality in patients with COVID-19.

OBJECTIVE: The aim of the study was to analyze the usefulness of CURB-65 and the pneumonia severity index (PSI) in predicting 30-day mortality in patients with COVID-19, and to identify other factors associated with higher mortality. METHODS: A retrospective study was performed in a pandemic hospital in Istanbul, Turkey, which included 681 laboratory-confirmed patients with COVID-19. Data on characteristics, vital signs, and laboratory parameters were recorded from electronic medical records. Receiver operating characteristic analysis was used to quantify the discriminatory abilities of the prognostic scales. Univariate and multivariate logistic regression analyses were performed to identify other predictors of mortality. RESULTS: Higher CRP levels were associated with an increased risk for mortality (OR: 1.015, 95% CI: 1.008-1.021; p < 0.001). The PSI performed significantly better than CURB-65 (AUC: 0.91, 95% CI: 0.88-0.93 vs AUC: 0.88, 95% CI: 0.85-0.90; p = 0.01), and the addition of CRP levels to PSI did not improve the performance of PSI in predicting mortality (AUC: 0.91, 95% CI: 0.88-0.93 vs AUC: 0.92, 95% CI: 0.89-0.94; p = 0.29). CONCLUSION: In a large group of hospitalized patients with COVID-19, we found that PSI performed better than CURB-65 in predicting mortality. Adding CRP levels to PSI did not improve the 30-day mortality prediction.

The effect of Misoprostol, a prostaglandin E1 analog, on apoptosis in ischemia-reperfusion-induced intestinal injury.

The aim of this study was to investigate whether Misoprostol, a synthetic prostaglandin (PG) E1 analog, has any effect on the prevention of apoptosis in ischemia-reperfusion (I/R)-induced intestinal injury. Thirty adult male Wistar albino rats were divided into three groups: group I=sham operated+saline; group II=I/R+saline; and group III=I/R+Misoprostol. Misoprostol (50microg/kg/d) was administered as an intragastric meal for 3 days. The terminal ileum was collected for histological and biochemical investigations. Apoptotic cells were detected by terminal deoxynucleotidyl transferase-mediated dUTP nick end-labelled (TUNEL) reaction. Immunohistochemical analysis was performed to determine the distribution of inducible nitric oxide synthase (iNOS) and endothelial NOS (eNOS). Samples were also analyzed for malondialdehyde (MDA), superoxide dismutase (SOD), and glutathione peroxidase (GSH-Px). The number of TUNEL-positive cells was higher in group II when compared to the other two groups (p<0.05). In group III this value was higher when compared to group I, but lower than group II (p<0.05). iNOS immunoreactivity was not detected in ileum sections of group I animals, but moderate immunoreactivity was seen in group II and mild immunoreactivity in group III. The immunoreactivity of eNOS was moderate in ileum sections of all three groups. In ileum tissue, MDA was found to be higher in group II compared to group I (p<0.05), but there was no difference in group III. SOD was not different between groups I and III, but was significantly higher in group II (p<0.05). In our experimental model of I/R-induced intestinal injury, apoptosis is induced in enterocytes, whereas Misoprostol decreases enterocyte apoptosis in this experimental model. Our results indicate that Misoprostol may play a key role in the pathophysiologic events leading to failure of the intrinsic gut barrier defense mechanisms of intestinal epithelium.