Evaluation of Patients with COVID-19 Followed Up in Intensive Care Units in the Second Year of the Pandemic: A Multicenter Point Prevalence Study.

OBJECTIVE: A 1-day point prevalence study was planned to obtain country data by determining the clinical characteristics, follow-up and treatment methods of coronavirus disease 2019 (COVID-19) cases that required intensive care unit (ICU) treatment in the second year of the pandemic. MATERIAL AND METHODS: All patients who were hospitalized in the ICUs due to COVID-19 between March 11, 2022, 08.00 am, and March 12, 2022, 08.00 am, were included in the study. Demographic characteristics, intensive care and laboratory data, radiological characteristics, and follow-up results of the patients were recorded. RESULTS: A total of 811 patients from 59 centers were included in the study, 59% of the cases were male, and the mean age was 74 ± 14 years. At least one comorbid disease was present in 94% of the cases, and hypertension was the most common. When ICU weight scores were examined, Acute Physiology and Chronic Health Evaluation-II: 19 (15-27) and Sequential Organ Failure Assessment: 7 (4-10) were seen. Sepsis was present in 37% (n = 298) of cases. PaO2/FiO2 ratios of the patients were 190 the highest and 150 the lowest and 51% of the cases were followed via invasive mechanical ventilation. On the study day, 73% bilateral involvement was seen on chest x-ray, and ground-glass opacities (52%) were the most common on chest tomography. There was growth in culture in 40% (n = 318) of the cases, and the most common growth was in the tracheal aspirate (42%). CONCLUSION: The clinical course of COVID-19 is variable, and ICU follow-up was required due to advanced age, comorbidity, presence of respiratory symptoms, and widespread radiological involvement. The need for respiratory support and the presence of secondary infection are important issues to be considered in the follow-up. Despite the end of the second year of the pandemic and vaccination, the high severity of the disease as well as the need for follow-up in ICUs has shown that COVID-19 is an important health problem.

Are there factors in the disease of peroneal necrotizing fasciitis which should be used when choosing the anesthetic technique?: Descriptive analysis of a cohort from two centers.

BACKGROUND: This study aims to examine the factors affecting the selection of anaesthesia method in Fournier's gangrene. METHODS: A retrospective evaluation was made of 113 patients operated on because of Fournier's gangrene between January-May 2019. The operations were performed under spinal anaesthesia in 78 cases (Group S) and under general anaesthesia in 35 cases (Group G). The patients were evaluated regarding age, gender, the anaesthesia method used (spinal, general) anaesthetic agent applied, presence of sepsis, and biochemical, hematological and inflammatory parameters. RESULTS: When the patients were evaluated regarding the Fournier Gangrene Severity Index (FGSI), patients in Group S had lower scores (p=0.001). Examination of the tomography images revealed that in 13 (37.1%) patients, air values were seen in the right or left gluteal area, or both, extending to the subcutaneous tissue. In the evaluation of the factors affecting the selection of general anaesthesia, a positive correlation was determined between an increase in FGSI (r=0.482, p=0.001) and the presence of sepsis (r=0.485, p=0.001) and gluteal region involvement (r=0.628, p<0.001). CONCLUSION: The selection of anaesthesia method in Fournier gangrene patients is a complex process affected by factors, such as the patients' general condition, sepsis, and whether or not there is bleeding diathesis. The risk -benefit balance in the selection of anaesthesia method should be evaluated individually for patients.

The psychological resilience and perceived stress of the frontline heroes in the pandemic in Turkey: A descriptive study of the COVID-19 outbreak-mutations-normalization triad.

AIM: To determine the psychological resilience and perceived stress levels of healthcare workers in COVID-19 intensive care units. METHODS: The study was conducted with 418 physicians and nurses in Turkey between July and August 2020. The data were collected with an online survey consisting of a personal information form, the Brief Resilience Scale, and the Perceived Stress Scale. RESULTS: The study sample comprised 32.5% physicians and 67.5% nurses. Fear of transmission of COVID-19 from the patients in their care was stated by 92.6% of the physicians and 95.7% of the nurses. Almost all of the participants (99.3%) were afraid of transmitting COVID-19 to their families. The psychological resilience level of the physicians (18.42 ± 2.25) participating in the study was higher than that of the nurses (17.88 ± 2.00), and the perceived stress level was lower. It was determined that most physicians and nurses strengthened their team/work friendship bonds during the pandemic, but the motivation to work decreased. CONCLUSION: The study results suggest that frontline intensive care workers should be closely monitored as a high-risk group for psychological problems. The provision of better personal protective equipment, together with on-going monitoring and provision of psychological support, and strong family support will increase the resilience of frontline healthcare workers.

The effect of the COVID-19 pandemic on community mental health: A psychometric and prevalence study in Turkey.

BACKGROUND: COVID-19, which is characterised by life-threatening symptoms, difficulty in breathing, and pneumonia symptoms and requires global emergency intervention, may cause psychological problems such as phobia, fear and anxiety. This study aims to examine the psychometric properties of the Fear of COVID-19 Scale (FCV-19S) in Turkish people and to determine the level of fear of COVID-19 among Turkish people. METHODS: The research was carried out between March and April 2020. A Personal Information Form and the FCV-19S were used to collect the research data. In the validity and reliability stage, 84 people were contacted randomly for data collection. After the validity and reliability analyses of the scale, a total of 431 Turkish people volunteered to participate in the study and answered the questions in the online questionnaire form using a convenience and snowball sampling method. Confirmatory factor analysis, item-total correlation and Cronbach's alpha coefficient were calculated for psychometric evaluation. Bivariate analysis was applied to determine the level of fear of COVID-19. RESULTS: Cronbach's alpha coefficient was 0.89, which is stated to have high reliability. FCV-19S scores of participants were determined to be 21.47 ± 6.28. FCV-19S scores of females were determined as 20.48 ± 6.33 and FCV-19S scores of males were determined as 19.78 ± 7.34 according to the bivariate analysis (p < .05). Age, marital status, having children and living alone or with others, tobacco use and anxiety about going to the hospital during the pandemic did not affect on fear of COVID-19 (p > .05). Particularly being female, the presence of chronic disease requiring long-term medication and rarely taking protective measures recommended by the Ministry of Health and having a chronic disease had a significant effect on higher levels of fear of COVID-19 (p < .05). CONCLUSION: The FCV-19S is a valid and reliable tool for determining the fear of COVID-19. It was found that the fear level of COVID-19 infection was high in Turkish people.

The assessment of the serum levels of TWEAK and prostaglandin F2α in COVID ­ 19

Background/aim: It is claimed that aberrant immune response has a more important role than the cytopathic effect of the virus in the morbidity and mortality of the coronavirus disease 2019 (COVID-19). We aimed to investigate the possible roles of tumor necrosis factor-like weak inducer of apoptosis (TWEAK)/Fn14 pathway and leukotrienes (LT) in uncontrolled immune response that occurs in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Materials and methods: This study included 25 asymptomatic patients and 35 patients with lung involvement who were diagnosed with COVID-19 as well as 22 healthy volunteers. Lung involvement was determined using computed-tomography. Serum TWEAK, LTE4, and prostaglandin F2α (PGF2α) levels were determined. Results: Compared with the healthy control group, TWEAK, LTE4, and PGF2α levels were higher in the group of SARS-CoV-2 infection without lung involvement. In the group of SARS-CoV-2 infection with lung involvement, age, fibrinogen, sedimentation, C-reactive protein and ferritin, TWEAK, LTE4, and PGF2α levels were higher, and lymphocyte levels were lower compared with the asymptomatic group. Conclusions: In the study, TWEAK and LTE4 levels increased in cases with COVID-19. These results support that TWEAK/Fn14 pathway and LT may involved in the pathology of aberrant immune response against SARS-CoV-2. Inhibition of each of these pathways may be a potential target in the treatment of COVID-19.

Comparison of the efficacy of surgical tracheostomy and percutaneous dilatational tracheostomy with flexible lightwand and ultrasonography in geriatric intensive care patients.

AIM: To compare the applicability, technical difficulties and postoperative complications of surgical tracheostomy and percutaneous dilatational tracheostomy with the flexible lightwand + ultrasonography method applied because of prolonged intubation to geriatric patients in the intensive care unit. METHODS: A retrospective evaluation was made of 76 patients who received surgical tracheostomy (group 1) and 78 patients who received percutaneous dilatational tracheostomy (group 2). The patients were evaluated in respect of demographic data, duration of intubation, length of stay in the intensive care unit and discharge status, and after the intervention, the development of tube-related complications, early stage local complications and late-stage complications. RESULTS: The time from intubation to tracheostomy was determined as 22.73 ± 15.23 days in group 1 and 12.65 ± 7.64 days in group 2. The mortality rate of patients in group 1 was determined to be statistically significantly higher than that of group 2 (P = 0.048). When evaluated in respect to early and late complications, nine early- and seven late-stage complications developed in group 1, and three early- and three late-stage complications developed in group 2 (P = 0.05). In the evaluation of factors related to mortality, the time from intubation to tracheostomy (r = 0.249, P = 0.01) and the presence of a comorbidity (r = 0.325, P = 0.004) were determined to have a positive correlation with the development of mortality. CONCLUSION: Percutaneous dilatational tracheostomy with the flexible lightwand + ultrasonography technique is a safe, rapid and effective method with the advantage of management in respect to early complications, such as bleeding, and can be used safely in the geriatric patient population in intensive care conditions. Geriatr Gerontol Int 2020; ••: ••-••.

The Effect of Flexible Lightwand and Ultrasonography Combination on Complications of the Percutaneous Dilatational Tracheostomy Procedure.

The aim of this study was to evaluate the effect of the flexible lightwand and ultrasonography (USG) combination on reducing the complications in percutaneous dilatational tracheostomy (PDT) opened with the forceps dilatation method. A retrospective examination was made of 138 patients between January 2014 and December 2018. Before starting to process, the anatomic structures of the patients were visualized with USG and the tracheostomy area was marked. Sedation and local anesthesia were applied to patients before the procedure, then the percutaneous tracheostomy was performed using the Griggs technique after confirmation of the tracheostomy localization defined with USG using the transillumination method with a flexible lightwand within an endotracheal tube. Complications that developed associated with the procedure were recorded. The mean age of the patients was 59.1±22.0 years and the mean length of stay in the intensive care unit was 42.3±35.5 days (range, 11-207 days). Overall, complications developed in 22 (15.6%) patients, of which 10.7% were early complications (1.4% related to the tube, 5.8% minor and 3.5% major complications). Tube- related complications were seen to develop in two patients. In the evaluation of the early minor complications, the most frequently seen complication was minor bleeding in 5.8% of the patients. No major vessel bleeding was determined in any patient in the early or late period. Of the late complications, the infection was seen to develop in four (2.8%) patients and stenosis in three (2.1%). The combination of flexible lightwand and USG in the PDT procedure minimized tube-related complications and contributed to the prevention of bleeding complications.

The Preseptic Period and Inflammatory Markers in the Prediction of the Course of Sepsis.

BACKGROUND The aim of this study was to find a simple and easily accessible scoring system that could predict the development of sepsis in the preseptic period. MATERIAL AND METHODS The study included 161 patients with a basal sequential organ failure assessment (SOFA) value of 2 or more. The sepsis group (n=83) comprised patients with infection reported in culture results; the control group (n=78) comprised patients not showing evidence of infection in blood, urine, and phlegm cultures; samples were taken on three consecutive days. RESULTS The patients in both groups were divided into subgroups of non-survivor and survivor patients. The preseptic and septic SOFA score, neutrophil lymphocyte ratio (NLR), and procalcitonin (PRC) and lactate (Lac) values were determined to be statistically significantly higher in the sepsis group than in the control group. When the values related to sepsis were examined, a strong relationship was determined between sepsis and SOFA score, PRC values, and Lac values in the preseptic period and a weak relationship with NLR. In the model formed using multiple regression analysis with defined cutoff values for the preseptic and the septic periods, we found that in the septic period, a diagnosis of sepsis could be made with 83.8% accuracy. The diagnostic value of the same parameters evaluated in the preseptic period was 77.9%. CONCLUSIONS The diagnostic value of the combination of Lac, PRC, SOFA, and NLR were found to be similar in the preseptic period as the sepsis period; thus these combined values could safely be used for the early diagnosis of sepsis.