The effect of therapeutic plasma exchange and intravenous immunoglobulin therapy on biomarkers and 28-day mortality in patients with COVID-19 in intensive care unit

Background: The aim of our study was to determine the effectiveness of the co-administration of therapeutic plasma exchange and intravenous immunoglobulin therapy in intensive care patients with COVID-19. Material and methods: In the propensity-matched study 46 patients were evaluated. The groups were defined as patients who received plasmapheresis + IVIg and standard treatment, and patients who received only standard treatment. The primary outcome of the study was determined as a 28-day mortality rate. Secondary outcome measures; demographic data were biomarkers of inflammation at admission and treatment days. Results: In the evaluation of 23 patients in 2 groups, no statistically significant difference was found between demographic data, vital and respiratory status, additional diseases and treatments applied (p>0.05) .There was no difference in 28-day mortality rates between the two groups (p:0.688). CRP, IL-6 and Ferritin Lymphocytes values in the TPE+IVIg group were lower when compared to the control group in the values measured after the treatment (p<0.05). All inflammatory markers applied in the Cox regression model were associated with survival and no association was found. Conclusion: In the results of this study, in which we applied TPE and IVIg treatment in combination, it was determined that this treatment method did not provide an additional benefit to the standard treatment. More clear information can be obtained by testing treatment applications in different doses and regimens and by randomized controlled studies

Annelerin 0-24 Aylık Çocuklarını Besleme Davranışları: Kırıkkale İli Örneği

Amaç: Bu çalışmanın amacı, Kırıkkale İl sınırları içinde yaşayan 0 -24 aylık çocukların anne sütü alma ve ek besinlere başlama duru-munda annelerin davranışlarını belirlemektir.Yöntem: Tanımlayıcı tipte olan bu çalışma, Kırıkkale İli merkez ve köylerinde yaşayan, 0-24 aylık çocuğu olan ve araştırmaya katılma-yı kabul eden 200 anneye 36 soru ve 5 bölümden oluşan bir anket formu uygulanmıştır.Bulgular: Annelerin %52’si kent merkezinde yaşamaktadır. Araştır-maya katılan annelerin %72.5’inin doğum sonrası ilk besin olarak bebeğine anne sütü verdiği, %57.5’inin çocuklarına ilk 6 ay anne sütü verdiği, annelerin %92.5’i anne sütü hakkında bilgi aldığı sap-tanmıştır. Annelerin %47.5’nin hemşire/ebelerden bilgi aldığı be-lirlenmiştir. Annelerin %36’sının 6 ay ve üzeri zamanda ek gıdaya başladığı saptanmıştır. Sonuç: Sonuç olarak, annelerin yarıdan fazlasının çocuklarına ilk altı ay sadece anne sütü verdiği, 6. aydan sonra ek gıdalara başla-dığı saptanmıştır

Hyperoxemia and excess oxygen use in early acute respiratory distress syndrome : Insights from the LUNG SAFE study

Publisher Copyright: © 2020 The Author(s). Copyright: Copyright 2020 Elsevier B.V., All rights reserved.Background: Concerns exist regarding the prevalence and impact of unnecessary oxygen use in patients with acute respiratory distress syndrome (ARDS). We examined this issue in patients with ARDS enrolled in the Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE (LUNG SAFE) study. Methods: In this secondary analysis of the LUNG SAFE study, we wished to determine the prevalence and the outcomes associated with hyperoxemia on day 1, sustained hyperoxemia, and excessive oxygen use in patients with early ARDS. Patients who fulfilled criteria of ARDS on day 1 and day 2 of acute hypoxemic respiratory failure were categorized based on the presence of hyperoxemia (PaO2 > 100 mmHg) on day 1, sustained (i.e., present on day 1 and day 2) hyperoxemia, or excessive oxygen use (FIO2 ≥ 0.60 during hyperoxemia). Results: Of 2005 patients that met the inclusion criteria, 131 (6.5%) were hypoxemic (PaO2 < 55 mmHg), 607 (30%) had hyperoxemia on day 1, and 250 (12%) had sustained hyperoxemia. Excess FIO2 use occurred in 400 (66%) out of 607 patients with hyperoxemia. Excess FIO2 use decreased from day 1 to day 2 of ARDS, with most hyperoxemic patients on day 2 receiving relatively low FIO2. Multivariate analyses found no independent relationship between day 1 hyperoxemia, sustained hyperoxemia, or excess FIO2 use and adverse clinical outcomes. Mortality was 42% in patients with excess FIO2 use, compared to 39% in a propensity-matched sample of normoxemic (PaO2 55-100 mmHg) patients (P = 0.47). Conclusions: Hyperoxemia and excess oxygen use are both prevalent in early ARDS but are most often non-sustained. No relationship was found between hyperoxemia or excessive oxygen use and patient outcome in this cohort. Trial registration: LUNG-SAFE is registered with ClinicalTrials.gov, NCT02010073publishersversionPeer reviewe

Evaluation of patients with candida infections in a tertiary care hospital’s general intensive care unit in Turkey.

INTRODUCTION: : Studies indicate that approximately 90% of the patients followed in the ICU have Candida spp colonization. In this study we aimed to elucidate the epidemiology, characteristics, management and outcomes of patients with candidemia in the intensive care unit of a training and research hospital. MATERIAL AND METHODS: All patients over the age of 18 who were hospitalized in general intensive care unit more than 24 hours between 2013 and 2019 were included in the this retrospective study. RESULTS: A total of 43 critically ill patients with blood cultures positive for Candida spp. have been enrolled in this retrospective analysis. The duration of stay in the intensive care unit of the survivors was approximately 53 days, while the average length of stay in the intensive care unit of the non survivors was 16 days, and this difference was statistically significant (p<0.05), 89.7% of septic patients with candidemia died the intensive care unit. There was a statistically significant difference between the two groups in terms of platelets, urea and systolic blood pressure (p<0.05), the mean platelet and systolic blood pressure values of the surviving patients were higher than the deceased individuals, while the urea value was lower. The average fungal growth time of the surviving individuals was 17 days, while this period was 1 day in the non-survivor patients. CONCLUSIONS: The mortality rate was higher in patients with sepsis and concomittant candida infection at very soon days of ICU hospitalization. Early administration of empirical antifungal therapy with coverage of non-albicans should be considered for septic patients

Yoğun Bakımda Santral Venöz Kateter Malpozisyonu: İki Olgu Sunumu

Santral venöz kateterizasyon yoğun bakımda tanı ve tedavi için sıklıkla kullanılan girişimsel bir tekniktir. Santral venöz kateterizasyon arter ponksiyonu, damar erozyonu, tromboz, malpozisyon ve enfeksiyon gibi komplikasyonlara neden olabilir. Biz bu makalede santral kateter yerleştirilen iki hastadaki kateter malpozisyonunu değerlendirmeyi amaçladık. 19 ve 72 yaşlarında iki hastamıza farklı iki endikasyonla santral venöz kateter yerleş- tirdik. Her iki hastada işlem sırasında herhangi bir komplikasyon gelişmedi. Ancak işlem sonrasında çekilen akciğer grafisinde kateter malpozisyonlarını tespit ettik. Kateter malpozisyonlarının belirlenmesinde işlem sonrası radyolojik görüntülemenin önemini vurgulamayı amaçladık. Ayrıca ultrason eşliğinde santral venöz kateterizasyon bu tür malpozisyonları önleyebilir ve komplikasyon oranlarını azaltabilir

Axillary Brachial Plexus Blockage in Treatment of Upper Extremity Ischemic Disorder in Critically Ill Patient: A Report of Two Cases

Arterial catheterization, vasoactive agents, autonomic dysfunction and septic embolus may cause ischemia at distal ends of upper extremity in critically ill patients. Axillary brachial plexus blockage is highly reliable intervention when appropriate technique is used. Sympathetic blockage occurs after administration of local anesthetic drug and can resolve the circulatory disorder of extremity. We aimed to present two cases with ischemia of upper distal extremity that resolves after axillary brachial plexus blockage

Genotyping of acineto bacter baumanni isolates from patients with severe sepsis in anesthesia intensive care unit

15th World-Federation-of-Societies-of-Anaesthesiologists (WFSA) World Congress of Anaesthesiologists -- MAR 25-30, 2012 -- Buenos Aires, ARGENTINAWOS: 000302299100161…World Federat Soc Anaesthesiol (WFSA

Cerebral Malaria Treated with Artemisinin in the Intensive Care Unit: A Case Report

Malaria is a parasitic disease that is starting to be encountered in intensive care units (ICU) worldwide, owing to increasing globalisation. Severe malaria caused by Plasmodium falciparum, is characterised by cerebral malaria, acute renal failure, hypoglycaemia, severe anaemia, splenomegaly and alveolar oedema. We present the case of a 25-yr old male patient who presented to the Emergency Department of Uludag University in Bursa, Turkey in the winter of 2014 with complaints of fe­ver for three days. His medical history revealed a 14-month stay in Tanzania. Staining of blood smears revealed characteristic gametocytes in accordance with P. falciparum infection. The day after admission, he had an epileptic seizure after which his Glasgow Coma Scale was 6, so he was intubated and transferred to the ICU. A computerized tomography scan revealed findings of cerebral oedema. Intravenous mannitol was administered for 6 days. Intravenous artemisinin was continued for 10 days. Due to refractory fevers, anti-malarial treatment was switched to quinine and doxycycline on the 14th day and on the 16th day the fe­vers ceased. This case emphasizes that cerebral malaria should be suspected in cases of seizures accompanying malaria, and treatment should be initiated in the ICU. Furthermore, resistance of P. falciparum to artemisinin should be in mind when a response to therapy is lacking