Evaluation of drug-drug interactions and side effects in COVID-19 patients in an intensive care unit

BACKGROUND/AIM: Considering comorbidity rates in patients diagnosed with coronavirus disease 2019 (COVID-19), polypharmacy will be inevitable when the treatment for COVID-19 is added to the treatment of existing chronic disease conditions. In our study, we evaluated the effects of comorbidities, drug-drug interactions and complications on the clinical course of the disease in COVID-19 patients. MATERIALS AND METHODS: This study was conducted retrospectively with thirty five COVID-19 patients of various age and gender groups who had been admitted to the intensive care unit in a university hospital in March and April, 2020. The demographic, laboratory and clinical data were collected. RESULTS: In our study, the average number of days intubated in patients with acute respiratory distress syndrome and sepsis was found to be statistically significantly higher than those without complications. serious-use alternative interaction was detected in 85.7% of the patients, monitor closely interaction in 60%, and minor interaction in 34.3%. In 88.6% of the patients, at least one of these interactions was observed, while all three interactions occurred at the same time in 20% of them. CONCLUSION: According to the results of this study, managing the risks, interventions such as drug dosage adjustment, and drug changes and monitoring of any parameters that may indicate drug side effects for the patient may be necessary

Evaluation of anxiety in doctors working in new type 2019 COVID and non-COVID services

Amaç: Bu çalışma İstanbul’da bir vakıf üniversitesi hastaneler kompleksinde yeni tip 2019 koronavirüs hastalığı (COVID) ve COVID dışı servislerde çalışan hekimlerde anksiyetenin değerlendirilmesi amacıyla yapılmış tanımlayıcı bir çalışmadır. Gereç ve Yöntem: Çalışma kapsamına, pandemi servislerinde çalışan 50, pandemi dışı servislerde çalışan 52 hekim alınmıştır. Veri toplama aracı olarak hekimlerin sosyo-demografik ve mesleki bazı özelliklerini içeren anket formu ve durumluk-süreklilik kaygı ölçeği kullanılmıştır. Veriler online anket uygulaması yoluyla toplanmıştır. Verilerin değerlendirilmesinde verilerin normal dağılım gösterip göstermediğine Shapiro-Wilk normallik testi ile bakılmıştır. Verilerin normal dağılım göstermediği için iki grup karşılaştırmalarında Mann-Whitney U testi, ikiden fazla grup karşılaştırmalarında ise Kruskal-Wallis testi kullanılmıştır. Korelasyon analizinde ise Pearson korelasyon analizi yapılmıştır. Bulgular: Çalışmamızda pandemi servislerinde çalışan hekimlerin durumluk kaygı puan ortalamalarının, pandemi dışı servislerde çalışan hekimlerin kaygı puan ortalamalarından daha yüksek olduğu ve aradaki farkın istatistiksel olarak anlamlı olduğu saptanmıştır (p<0,05). Cinsiyete göre pandemi servisinde çalışan kadın hekimlerin durumluk kaygı puan ortalamalarının erkek hekimlerden daha yüksek ve farkın istatistiksel olarak önemli olduğu belirlenmiştir (p<0,05). Yaş gruplarına göre pandemi servislerinde çalışan 43 yaş ve üzerindeki hekimlerin süreklilik kaygı puan ortalamalarının diğer yaş gruplarındaki hekimlerden daha düşük ve farkın istatistiksel olarak önemli olduğu saptanmıştır (p<0,05). Hem pandemi servislerinde çalışan hekimlerin hem de pandemi servisleri dışında çalışan hekimlerin durumluk ve süreklilik kaygı ölçeği puan ortalamaları arasında pozitif yönlü kuvvetli ilişki saptanmıştır (p<0,05). Yani durumluk kaygı arttıkça süreklilik kaygı, süreklilik kaygı arttıkça durumluk kaygı da artmaktadır. Sonuç: Çalışmamızda pandemi servislerinde çalışan hekimlerin durumluk kaygısının diğer servislerde çalışan hekimlerden daha fazla olduğu ve süreklilik kaygısı arasında bir fark bulunamaması pandemi servisinde çalışmanın anksiyeteye neden olduğunu göstermektedir.Objective: This descriptive study was conducted in a foundation university hospital complex in Istanbul and aimed to evaluate the anxiety in physicians who provide new type 2019 coronavirus disease (COVID) related and non-COVID-19-related services. Materials and Methods: This study included 50 physicians who provide COVID-19-related services and 52 physicians with non-COVID-19-related services. A questionnaire that contains sociodemographic and occupational characteristics of physicians and a state-trait anxiety scale were used as data collection tools. Data were collected through an online survey application. Data analysis checked the variable distribution using the Shapiro-Wilk normality test. Since no normal distribution was found, the Mann-Whitney U test was used for comparisons of two groups, and the Kruskal-Wallis test was used for comparisons of more than two groups. The Pearson correlation analysis was performed for correlation analysis. Results: Our study determined significantly higher mean state anxiety scores of physicians who provide COVID-19-related services than that of the other group (p<0.05). According to age groups, the mean trait anxiety scores of physicians aged 43 years and over who provide COVID-19-related services were significantly lower than that in physicians who provide non-COVID-19-related services (p<0.05). A strong positive correlation was found in the state and trait anxiety scale mean scores between both groups (p<0.05). Therefore, state and trait anxiety increase in correlation. Conclusion: Our study revealed higher state anxiety of physicians who provide COVID-19-related services than that of physicians who provide non-COVID-19-related services. Additionally, no difference was found in the trait anxiety, which indicates that working in the pandemic services causes anxiety

Sequential Application of Oxygen Therapy via High-flow Nasal Cannula and Non-invasive Ventilation in COVID-19 Patients with Acute Respiratory Failure in the Intensive Care Unit: A Prospective, Observational Study

Objective:Non-invasive mechanical ventilation (NIV) and high-flow nasal oxygen therapy (HFNO) are the most frequently used methods for treating hypoxemia in those diagnosed with coronavirus disease-2019 (COVID-19) in the intensive care unit (ICU). In this prospective study, we compared the effects of these two treatment modalities applied alternately in the same patient.Materials and Methods:Standard oxygen therapy (SOT) was administered for 1 hour to patients hospitalized in the ICU with a diagnosis of acute hypoxemic respiratory failure (AHRF) and acute respiratory distress syndrome (ARDS) due to COVID-19. HFNO and NIV were applied alternately to patients who met the inclusion criteria, and we evaluated the effects of HFNO and NIV applied to the same patient.Results:Thirty of forty-five patients admitted to the ICU for COVID-19 ARDS met the inclusion criteria for the study. According to the first and second arterial blood gas (ABG) values, the PaO2/FiO2 (P/F) ratio was significantly higher during NIV compared to both baseline and HFNO. In addition, the ROX index was significantly higher during NIV than HFNO, and SpO2 in NIV increased significantly compared with the baseline value. In both methods, patient satisfaction according to the visual analog scale was better than that of SOT. Eighty percent (24/30) of the patients were orotracheally intubated; 13 patients were transferred to the ward (43.3%), 2 patients were discharged home (6.7%), and 15 patients died (50%).Conclusion:Starting respiratory support with HFNO and/or NIV rather than SOT is more effective in improving oxygenation in patients with AHRF and ARDS due to COVID-19 and other causes. NIV is more effective than HFNO in increasing the SpO2 and P/F ratio

Kardiyak arrest sonrası detaylı terapötik hipotermi protokolü

Sudden cardiac arrest occurs in an average of 375,000 people every year in Europe (1). Cardiac arrest lasting five minutes or longer results in cerebral injury (1). In order to achieve better neurological results and improve outcomes, targeted temperature management (TTM) protocols have been developed, following clinical trials that showed good outcomes in out-of-hospital cardiac arrest (1,2). TTM protocols have been recommended in European guidelines (3)

Cryptococcus neoformans meningoencephalitis in an HIV-seronegative patient: A case report

Background Cryptococcal meningoencephalitis is an important opportunistic infection that usually affects immunocompromised patients. Usually seen in HIV (human immune deficiency virus)-seropositive patients, Cryptococcus neoformans may also be seen in patients who receive immune-suppressing glucocorticoid treatment, undergo solid organ transplant, have cancer, especially hematologic malignancies, and liver failure (Messina et al. 2017). However, in rare cases, Cryptococcal meningoencephalitis can be seen in suspected immunocompetent patients as well

Perkütan endoskopik gastrostomide tek merkez deneyimi

Amaç: Gastrostomiler oral alım yetersizliği olan hastalarda uzun süreli enteral tedaviyi sağlamak için kullanılmaktadır. Günümüzde cerrahi ve radyolojik gastrostomilere göre komplikasyon oranlarındaki düşüklük ve hasta başında daha kolay yapılabilmesi nedeniyle perkütan endoskopik gastrostomiler (PEG) daha çok tercih edilmektedir. Bu retrospektif çalışmanın amacı, PEG yapılan hastaların değerlendirilmesidir. Gereç ve Yöntem: Ocak 2014 - Ocak 2019 tarihleri arasında İstanbul Medipol Üniversitesi Tıp Fakültesi Hastanesi Yoğun Bakım Ünitesi'nde, PEG yapılan 325 hasta retrospektif olarak incelendi. Bu hastaların demografik ve klinik özellikleri ile işlem sonrası sonuçları değerlendirildi. Bulgular: Hastaların yaş ortalaması 63.8±18.1 yıldı. Bu hastaların 200'ü (%61.5) erkekti. Hastalarda en sık PEG takılma endikasyonu serebrovasküler hastalıktı (SVH) (%27.7). Hastalarda en sık görülen komplikasyon tüp kenarından sızıntıydı (%4.6). Bu hastalarda PEG ile ilişkili mortalite gelişmedi. Oral beslenmesi düzelen 25 (%7.6) hastada PEG tüpü çekildi. Sonuç: Hasta başında kolaylıkla uygulanabilmesi, komplikasyon ve mortalite oranlarının son derece düşük olması nedeniyle özellikle oral alımın yetersiz olduğu kritik hastalarda, enteral tedavilerin sürdürülebilmesi için PEG işlemi uygun görünmektedir.Objective: Gastrostomies are used to provide long-term enteral treatment in patients with inadequate oral intake. Today, percutaneous endoscopic gastrostomies (PEG) are preferred more because of the low complication rates compared to surgical and radiological gastrostomies and can be performed more easily at the bedside. The aim of this retrospective study is to evaluate patients undergoing PEG. Materials and Methods: Between January 2014 and January 2019, 325 patients who underwent PEG at the Istanbul Medipol University Medical Faculty Hospital Intensive Care Unit were retrospectively analyzed. The demographic and clinical features of these patients and postprocedure results were evaluated. Results: The mean age of the patients was 63.8±18.1 years. 200 (61.5%) of these patients were male. The most common indications for PEG implantation were cerebrovascular diseases (SVD) (27.7%). The most common complication in patients was leakage from the side of the tube (4.6%). PEG associated mortality did not develop in these patients. PEG tube was removed in 25 (7.6%) patients whose oral feeding improved. Conclusion: PEG procedure seems appropriate for the maintenance of enteral treatments, especially in critically ill patients with poor oral intake, due to its easy application at the bedside, the low complication and mortality rates

Alternative treatment method for novel coronavirus disease 2019: Coupled plasma filtration adsorption

Dear editor: Patients infected with severe acute respiratory syndrome corona virus 2 may have mild symptoms such as fever and cough in the early stage of this disease and these symptoms may deteriorate to acute respiratory distress syndrome, multiple-organ failure, and death in the late phase.1 It has been reported that the cytokine levels increase and damage the tissues.2 As some agents used to decrease cytokine levels such as intravenous immunoglobulin and selective cytokine blockade (eg, anakinra or tocilizumab) may cause adverse events (infections, allergic reactions, and changes in blood pressure), there is a need of alternative treatment methods.3 Herein, we present our coupled plasma filtration adsorption (CPFA) (a detoxification system combining a plasma adsorption circuit) with a continuous renal replacement therapy (CRRT) experiences to treat 2 patients with coronavirus disease (COVID-19) in our tertiary university hospital intensive care unit (ICU)

Assessment of job satisfaction, work-related strain, and perceived stress in nurses working in different departments in the same hospital: A survey study

ObjectiveWe aimed to evaluate whether working at ICU, inpatient services, or the operating room creates differences in job satisfaction (JS), work-related strain (WRS), and perceived stress (PS) of nurses.Research methodologyThe study data were collected through face-to-face interviews. The data collection tools utilized in the study included a questionnaire form consisting of 19 questions.Work-Related Strain Inventory (WRSI), Short-Form Minnesota Job Satisfaction Questionnaire (SF-MSQ), and the Perceived Stress Scale (PSS) were used.ResultsAcross all groups, the mean scores of SF-MSQ were statistically significantly the lowest in the groups of nurses, who were not economically satisfied with their salaries at all, who reported that they did not do their dream jobs and that they were not fond of their jobs.The mean scores of WRSI were statistically significantly the lowest across all groups in the groups of nurses.The mean PSS scores were statistically significantly the lowest across all compared groups in the groups of nurses, who commute to work by their private cars.ConclusionHospital management and nursing services should address the overtime working conditions of nurses and provide satisfactory wage improvements

High-dose intravenous immunoglobulin therapy for novel coronavirus disease 2019: A brief report of two cases

To the Editor,Novel coronavirus disease 2019 (2019-nCoV) is a global pandemic which threatens all over the world. Thefirst cases were seen in Wuhan, China, in December2019 (Guo et al. 2020; Chen et al. 2020). It has spreadrapidly, and now, there are more than 2.3 million reported cases and 160,000 deaths worldwide. 2019-nCoVmay cause multi-system infections especially respiratoryinfections such as severe acute respiratory syndrome(SARS) and Middle East respiratory syndrome (MERS)(Guo et al. 2020; Chen et al. 2020; Sanders et al. 2020).In some cases, infections may be mild (only cough orfever, etc.); however, in some cases, infections may be severe (acute respiratory failure with diffuse pneumonia).In severe cases, there is an exaggerated immune response with low peripheral lymphocyte levels and highcytokine levels. This mechanism of pathogenesis may beresponsible for the multiple organ failures (Cao et al.2019; Lin et al. 2020). In this early stage of the 2019-nCoV, the infection may be treated successfully withimmunomodulation (Cao et al. 2019). So, the immunomodulation options like intravenous immunoglobulinshould be kept in mind. The intravenous immunoglobulin (IVIg) has been used as a replacement therapy insome immunodeficiency syndromes (Ballow 2008; DeRanieri 2017). IVIg plays an immunomodulatory andanti-inflammatory role in such cases like 2019-nCoV(Cao et al. 2019; Lin et al. 2020)