Treatment In Intensive Care Unit Research Articles

Pneumothorax occuring during the final stage of treatment in miliary tuberculosis patients

Air in the pleural space can cause lung collapse and respiratory discomfort, which can be life-threatening in very ill patients, making pneumothorax a medical emergency. Since tubercle bacilli can travel through the blood to the lungs and other organs, Miliary Tuberculosis (TB) is a disseminated disease that can be lethal. We present a case of a 36-year-old male with Pneumothorax Occuring during the Final Stage of Treatment in Million Tuberculosis Patients. The patient is currently undergoing outpatient treatment of miliary TB for the 11th month and so far his condition is getting better, however was admitted to the emergency unit of the hospital, diagnosed with left pneumothorax based on clinical, laboratory, and radiology showing. In meanwhile, 88% of the room air was saturated with oxygen, necessitating Intensive Care Unit treatment with HFNC FiO2 100 Flow 60, followed by high consentration oxygen therapy with a non-rebreathing mask (NRM) of 15 litres/minute. Combivent inhalation and pulmicort inhalation were given every 15 minutes. The family refused to install a water sealed drainage or chest tube in the patient. The patient was also given treatments with ceftriaxone, citicolin, methylprednisolone, omeprazole and the advanced phase of tuberculosis drugs namely Rifampicin 450 mg and Isoniazid 300 mg. On the 6th day of treatment in the ICU, the patient's condition improved and the pneumothorax decreased. In this case, the likelihood of Pneumothorax in patients with miliary tuberculosis needs to be emphasized, as well as the importance of evaluation and strict follow-up to prevent the occurrence of pneumothorax.

Decreased level of serum NT-proCNP associates with disease severity in COVID-19

BackgroundC-type natriuretic peptide (CNP) is an endothelium-derived paracrine molecule with an important role in vascular homeostasis. In septic patients, the serum level of the amino-terminal propeptide of CNP (NT-proCNP) shows a strong positive correlation with inflammatory biomarkers and, if elevated, correlates with disease severity and indicates a poor outcome. It is not yet known whether NT-proCNP also correlates with the clinical outcome of patients suffering from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. In the current study, we aimed to determine possible changes in the NT-proCNP levels of patients with coronavirus disease 2019 (COVID-19), with special regard to disease severity and outcome.MethodsIn this retrospective analysis, we determined the serum level of NT-proCNP in hospitalized patients with symptoms of upper respiratory tract infection, using their blood samples taken on admission, stored in a biobank. The NT-proCNP levels of 32 SARS-CoV-2 positive and 35 SARS-CoV-2 negative patients were measured to investigate possible correlation with disease outcome. SARS-CoV-2 positive patients were then divided into two groups based on their need for intensive care unit treatment (severe and mild COVID-19).ResultsThe NT-proCNP was significantly different in the study groups (e.g. severe and mild COVID-19 and non-COVID-19 patients), but showed inverse changes compared to previous observations in septic patients: lowest levels were detected in critically ill COVID-19 patients, while highest levels in the non-COVID-19 group. A low level of NT-proCNP on admission was significantly associated with severe disease outcome.ConclusionsLow-level NT-proCNP on hospital admission is associated with a severe COVID-19 disease course. The pathomechanism underlying this observation remains to be elucidated, while future studies in larger patient cohorts are necessary to confirm these observations and reveal therapeutic importance.Trial registration DRKS00026655 Registered 26. November 2021

Single fibre cytoarchitecture in ventilator-induced diaphragm dysfunction (VIDD) assessed by quantitative morphometry second harmonic generation imaging: Positive effects of BGP-15 chaperone co-inducer and VBP-15 dissociative corticosteroid treatment.

Ventilator-induced diaphragm dysfunction (VIDD) is a common sequela of intensive care unit (ICU) treatment requiring mechanical ventilation (MV) and neuromuscular blockade (NMBA). It is characterised by diaphragm weakness, prolonged respirator weaning and adverse outcomes. Dissociative glucocorticoids (e.g., vamorolone, VBP-15) and chaperone co-inducers (e.g., BGP-15) previously showed positive effects in an ICU-rat model. In limb muscle critical illness myopathy, preferential myosin loss prevails, while myofibrillar protein post-translational modifications are more dominant in VIDD. It is not known whether the marked decline in specific force (force normalised to cross-sectional area) is a pure consequence of altered contractility signaling or whether diaphragm weakness also has a structural correlate through sterical remodeling of myofibrillar cytoarchitecture, how quickly it develops, and to which extent VBP-15 or BGP-15 may specifically recover myofibrillar geometry. To address these questions, we performed label-free multiphoton Second Harmonic Generation (SHG) imaging followed by quantitative morphometry in single diaphragm muscle fibres from healthy rats subjected to five or 10days of MV + NMBA to simulate ICU treatment without underlying confounding pathology (like sepsis). Rats received daily treatment of either Prednisolone, VBP-15, BGP-15 or none. Myosin-II SHG signal intensities, fibre diameters (FD) as well as the parameters of myofibrillar angular parallelism (cosine angle sum, CAS) and in-register of adjacent myofibrils (Vernier density, VD) were computed from SHG images. ICU treatment caused a decline in FD at day 10 as well as a significant decline in CAS and VD from day 5. Vamorolone effectively recovered FD at day 10, while BGP-15 was more effective at day 5. BGP-15 was more effective than VBP-15 in recovering CAS at day 10 although not to control levels. In-register VD levels were restored at day 10 by both compounds. Our study is the first to provide quantitative insights into VIDD-related myofibrillar remodeling unravelled by SHG imaging, suggesting that both VBP-15 and BGP-15 can effectively ameliorate the structure-related dysfunction in VIDD.

Impact of the COVID-19 pandemic on the care of major trauma patients: analysis from the TraumaRegister DGU®

The treatment of major trauma patients requires intensive care capacity, which is acritical resource particularly during the coronavirus disease 2019 (COVID-19) pandemic. Therefore, the aim of this study was to analyze the impact on major trauma care considering the intensive care treatment of COVID-19 positive patients. Demographic, prehospital, and intensive care treatment data from the TraumaRegister DGU® of the German Trauma Society (DGU) in 2019 and 2020 were analyzed. Only major trauma patients from the state of Bavaria were included. Inpatient treatment data of COVID-19 patients in Bavaria in 2020 were obtained using IVENA eHealth. In total, 8307 major trauma patients were treated in the state of Bavaria in the time period investigated. The number of patients in 2020 (n = 4032) compared to 2019 (n = 4275) was not significantly decreased (p = 0.4). Regarding COVID-19 case numbers, maximum values were reached in the months of April and December with more than 800 intensive care unit (ICU) patients per day. In the critical period (> 100patients with COVID-19 on ICU), aprolonged rescue time was evident (64.8 ± 32.5 vs. 67.4 ± 30.6 min; p = 0.003). The length of stay and ICU treatment of major trauma patients were not negatively affected by the COVID-19 pandemic. The intensive medical care of major trauma patients could be ensured during the high-incidence phases of the COVID-19 pandemic. The prolonged prehospital rescue times show possible optimization potential of the horizontal integration of prehospital and hospital.

CONSTRUCTION OF ALTERNATIVE COMMUNICATION INSTRUMENT TO ACCESS BASIC EMOTIONS IN ICU PATIENTS

Introduction: Patients under treatment in intensive care units (ICU) may have communicative restrictions caused by various factors such as tracheostomy, intubation, and muscle weakness. The use of alternative and augmentative communication resources (CAA) aims to break the existing communication barriers and enable the individual a way to express themselves. Objectives: To build non-verbal communication boards aiming to identify basic emotions in ICU patients and evaluate their contribution and effectiveness when used with patients in speech deprivation conditions. Method: This is an exploratory study, with a quali-quantitative approach, divided into three stages: Step 1: Preliminary study, with the testing of stimuli representative of basic emotions, with a sample of 543 subjects. Step 2: Comparison of the presentation of the stimuli in the physical and digitized version involving a non-clinical population, composed of 60 individuals. Stage 3: case study with one participant, male, 65 years old, admitted to an ICU. Results: A board was developed containing 8 basic emotions and a neutral face and a board with a thermometer to measure the intensity of emotions. There were no significant differences in the application of the board in physical and virtual modality. In the application of the physical boards in participant of a ICU, this indicated that the boards contributed to the communication of their emotions. Conclusion: Considering the importance of the use of (AAC) and its implication in the mental health of the subject the boards were characterized as effective in the psychological care to the patient and emotional evaluation of the latter.

Cross-national associations of IQ and infectious diseases: Is the prevalence of Corona an exceptional case?

BACKGROUND: Previous studies reported negative associations between a country’s mean IQ and economic development at the one side and the prevalence of infectious diseases on the other, arguing that a more rational behavior and better living conditions decreased health risks. The purpose of this study was to transfer these previous findings on the relationship between IQ and the burden of infectious diseases on a cross-national level to the SARS-CoV-2 pandemic. Countries with higher IQ results and rich countries in North-East Asia and the West are more affected by Corona than poorer countries in the Middle East or in sub-Saharan Africa (IQ: _r_IQ↔Cases = .41 and _r_IQ↔Deaths = .28; wealth: _r_GDP/c↔Cases = .45 and _r_GDP/c↔Deaths = .22). Intelligence can have contradicting effects on Corona, i.e., it increases health and makes people more rationally cautious, but at the same time leads to an older population that is more susceptible to corona health problems and allows societies to detect more Corona cases. METHODS: The effects of IQ on the impact of the SARS-CoV-2 pandemic (per capita: reproduction rate_ R_0, hospitalizations due to Corona, Intensive Care Unit treatments, cases, deaths, excess mortality) were controlled in a sample of up to 207 countries for climatic conditions, air pollution, wealth, demographic factors, health burden (e.g., cardiovascular diseases), peoples’ mobility, test coverage and anti-Corona regulations. The stability of effects was checked in six country sub-samples and controlled for the factors named above in regressions with 73 successful runs. RESULTS: The effect (standardized β) of IQ shows an average negative (reducing) effect of –.19 on the pandemic’s impact. Intelligence has a small effect on the spread of corona and the severity of its consequences. Stronger effects are given by climatic conditions (colder climates) and air pollution. Detailed regressions and additional path analyses show that the reducing effect of IQ is limited to the direct path and the long term (β = .08 in 2020 but –.21 in 2021). CONCLUSIONS: In the context of the SARS-CoV-2 pandemic, the previous findings about the relationship between IQ and the burden of infectious diseases could only be partially reproduced. The assumption of a weakening effect on the impact of the pandemic was confirmed, but only to a limited extent and along unknown ways.

EE400 Economic Impact of Clinical Pharmacist Interventions in the Neonatal Intensive Care Unit in Qatar

The economic benefit of the clinical pharmacist’s role in ensuring the optimum use of medicines is potentially considerable, particularly when it comes to critical care management. This study sought to evaluate the overall economic impact of clinical pharmacist interventions in the main Neonatal Intensive Care Unit (NICU) in Qatar.

Individualized Goal Setting for Pediatric Intensive Care Unit-Based Rehabilitation Using the Canadian Occupational Performance Measure.

The Canadian Occupational Performance Measure (COPM) is a client-centered outcome measure that facilitates the prioritization of individualized interventions. Given the rising emphasis on individualized intervention in pediatric intensive care units (PICUs), this cross-sectional study aimed to explore caregivers' perspectives on their children's functional goals within PICUs. From 1 September 2020 to 26 June 2022, caregivers of 41 children aged 1-18 years completed the COPM within 48 h of PICU admission. The study also explored the clinical variables predicting a high number of occupational performance goals (≥4/5). Out of 190 goals proposed by caregivers, 87 (45.8%) pertained to occupational performance, while 103 (54.2%) were related to personal factors. Among the occupational performance goals, the majority were associated with functional mobility (55; 28.9%), followed by personal care (29; 15.2%) and quiet recreation (3; 1.6%). Among personal goals, physiological factors (68; 35.8%) were most common, followed by physical factors (35; 18.4%). We found caregiver anxiety, measured by the State-Trait Anxiety Inventory-State, to be a significant predictor of the number of occupational performance goals. These findings underscore the importance of caregiver psychological assessment in the PICU to facilitate personalized goal setting and improve rehabilitation outcomes.

Vitamin D supplementation improved physical growth and neurologic development of Preterm Infants receiving Nesting Care in the neonatal Intensive Care Unit

ObjectiveTo study the effects of vitamin D supplementation on physical growth and neurologic development of very preterm infants receiving nesting intervention in the neonatal intensive care unit (NICU).MethodsA total of 196 preterm infants had been hospitalized in NICU with the gestational age (GA) between 28 and 32 weeks. Among them, 98 preterm infants received nesting intervention, and the other 98 cases received both nesting and vitamin D supplementation (400 IU). The interventions were continued until 36 weeks postmenstrual age (PMA). The 25(OH)D serum levels, anthropometric parameters, and Premie-Neuro (PN) scores were compared at 36 weeks PMA.ResultsHigher median serum level of 25(OH)D was found in the nesting + vitamin D [38.40 ng/mL (IQR: 17.20 ~ 70.88) ng/mL] as compared to the nesting group [15.95 ng/mL (IQR: 10.80 ~ 24.30) ng/mL] at 36 weeks PMA. Besides, infants receiving combined nesting intervention and vitamin D supplementation had less proportion of vitamin D deficiency [VDD, 25(OH)D levels < 20 ng/mL] than those receiving nesting intervention alone. After intervention, the anthropometric parameters of infants, including weight, length, BMI and head circumference were improved in the nesting + vitamin D group as compared to the nesting group at 36 weeks PMA, with higher scores of neurological, movement and responsiveness.ConclusionsVitamin D supplementation effectively decreased the prevalence of VDD and led to higher concentrations of 25(OH)D at 36 weeks PMA. This was one more study that supported the necessity of vitamin D supplementation to improve physical growth and neurologic development of preterm-born newborns who received nesting intervention in the NICU.

Impact of Serum Lactate as an Early Serum Biomarker for Cardiopulmonary Parameters within the First 24 Hours of Intensive Care Unit Treatment in Patients with Isolated Traumatic Brain Injury.

Cardiopulmonary (CP) complications are well-known phenomena in patients with isolated traumatic brain injury (iTBI) that can lead to tissue hypoperfusion and hypoxia. Serum lactate level is a well-known biomarker, indicating these systemic dysregulations in various diseases, but this has not been investigated in iTBI patients so far. The current study evaluates the association between serum lactate levels upon admission and CP parameters within the first 24 h of intensive care unit (ICU) treatment in iTBI patients. 182 patients with iTBI who were admitted to our neurosurgical ICU between December 2014 and December 2016 were retrospectively evaluated. Serum lactate levels on admission, demographic, medical, and radiological data upon admission, as well as several CP parameters within the first 24 h of ICU treatment, were analyzed, as well as the functional outcome at discharge. The total study population was dichotomized into patients with an elevated serum lactate level (lactate-positive) and patients with a low serum lactate level (lactate-negative) upon admission. 69 patients (37.9%) had an elevated serum lactate level upon admission, which was significantly associated with a lower Glasgow Coma Scale score (p = 0.04), a higher head AIS score (p = 0.03), and a higher Acute Physiology and Chronic Health Evaluation II score (p = 0.01) upon admission, as well as a higher modified Rankin Scale score (p = 0.002) and a lower Glasgow Outcome Scale score (p < 0.0001) at discharge. Furthermore, the lactate-positive group required a significantly higher norepinephrine application rate (NAR; p = 0.04) and a higher fraction of inspired oxygen (FiO2; p = 0.04) to maintain the defined CP parameters within the first 24 h. ICU-admitted iTBI patients with elevated serum lactate levels upon admission required higher CP support within the first 24 h of ICU treatment after iTBI. Serum lactate may be a helpful biomarker for improving ICU treatment in the early stages.

Retrospective evaluation of therapeutic plasma exchange treatment in a pediatric intensive care unit: Single-center experience.

The aim of this study is to characterize the clinical indications, outcomes, and complications of therapeutic plasma exchange (TPE) in pediatric intensive care unit. A retrospective study was conducted on critically ill patients who received TPE. A dataset of 672 treatments administered to 102 patients was analyzed. The most common indication for TPE was COVID-19-related clinical conditions, followed by sepsis (24.5%), neurological diseases (9.8%) and renal diseases (6.9%). None of our patients died due to TPE-related complications, and the most common complication during and after the TPE was hypotension (21.7%). Although TPE is riskier to provide to critically ill children, our experience indicates that it can be performed relatively safely in critically ill children with appropriate treatment indications. In particular, indications, onset time, number of sessions and other procedures should be standardized for the pediatric age group.

The Epidemiology of Spondylodiscitis in Germany: A Descriptive Report of Incidence Rates, Pathogens, In-Hospital Mortality, and Hospital Stays between 2010 and 2020.

Spondylodiscitis can lead to significant morbidity and mortality. Understanding its up-to-date epidemiological characteristics and trends is important to improve patient care. This study analyzed trends in the incidence rate of spondylodiscitis cases in Germany between 2010 and 2020, as well as the pathogens, in-hospital mortality rate, and length of hospital stay. Data were obtained from the Federal Statistical Office and the Institute for the Hospital Remuneration System database. The ICD-10 codes "M46.2-", "M46.3-" and "M46.4-" were evaluated. The incidence rate of spondylodiscitis increased to 14.4/100,000 inhabitants, with 59.6% cases occurring in patients 70 years or older and affecting mainly the lumbar spine (56.2%). Absolute case numbers increased from 6886 by 41.6% to 9753 in 2020 (IIR = 1.39, 95% CI 0.62-3.08). Staphylococci and Escherichia coli were the most coded pathogens. The proportion of resistant pathogens was 12.9%. In-hospital mortality rates increased to a maximum of 64.7/1000 patients in 2020, intensive care unit treatment was documented in 2697 (27.7%) cases, and the length of stay per case was 22.3 days. The sharply increasing incidence and in-hospital mortality rate of spondylodiscitis highlights the need for patient-centered therapy to improve patient outcomes, especially in the geriatric, frail population, which is prone to infectious diseases.

Barriers and opportunities for implementation of a brief psychological intervention for post-ICU mental distress in the primary care setting – results from a qualitative sub-study of the PICTURE trial

BackgroundThe results of critical illness and life-saving invasive measures during intensive care unit treatment can sometimes lead to lasting physical and psychological impairments. A multicentre randomized controlled trial from Germany (PICTURE) aims to test a brief psychological intervention, based on narrative exposure therapy, for post-traumatic stress disorder symptoms following intensive care unit treatment in the primary care setting. A qualitative analysis was conducted to understand feasibility and acceptance of the intervention beyond quantitative analysis of the main outcomes in the primary study.MethodsQualitative explorative sub-study of the main PICTURE trial, with eight patients from the intervention group recruited for semi-structured telephone interviews. Transcriptions were analysed according to Mayring's qualitative content analysis. Contents were coded and classified into emerging categories.ResultsThe study population was 50% female and male, with a mean age of 60.9 years and transplantation surgery being the most frequent admission diagnosis. Four main factors were identified as conducive towards implementation of a short psychological intervention in a primary care setting: 1) long-term trustful relationship between patient and GP team; 2) intervention applied by a medical doctor; 3) professional emotional distance of the GP team; 4) brevity of the intervention.ConclusionThe primary setting has certain qualities such as a long-term doctor-patient relationship and low-threshold consultations that offer good opportunities for implementation of a brief psychological intervention for post-intensive care unit impairments. Structured follow-up guidelines for primary care following intensive care unit treatment are needed. Brief general practice-based interventions could be part of a stepped-care approach.Trial registrationThe main trial was registered at the DRKS (German Register of Clinical Trials: DRKS00012589) on 17/10/2017.

Opportunities to improve diagnosis in emergency transfers to the pediatric intensive care unit.

Late recognition of in-hospital deterioration is a source of preventable harm. Emergency transfers (ET), when hospitalized patients require intensive care unit (ICU) interventions within 1 h of ICU transfer, are a proximal measure of late recognition associated with increased mortality and length of stay (LOS). To apply diagnostic process improvement frameworks to identify missed opportunities for improvement in diagnosis (MOID) in ETs and evaluate their association with outcomes. A single-center retrospective cohort study of ETs, January 2015 to June 2019. ET criteria include intubation, vasopressor initiation, or 60 mL/kg fluid resuscitation 1 h before to 1 h after ICU transfer. The primary exposure was the presence of MOID, determined using SaferDx. Cases were screened by an ICU and non-ICU physician. Final determinations were made by an interdisciplinary group. Diagnostic process improvement opportunities were identified. Primary outcomes were in-hospital mortality and posttransfer LOS, analyzed by multivariable regression adjusting for age, service, deterioration category, and pretransfer LOS. MOID was identified in 37 of 129 ETs (29%, 95% confidence interval [CI] 21%-37%). Cases with MOID differed in originating service, but not demographically. Recognizing the urgency of an identified condition was the most common diagnostic process opportunity. ET cases with MOID had higher odds of mortality (odds ratio 5.5; 95%CI 1.5-20.6; p = .01) and longer posttransfer LOS (rate ratio 1.7; 95%CI 1.1-2.6; p = .02). MOID are common in ETs and are associated with increased mortality risk and posttransfer LOS. Diagnostic improvement strategies should be leveraged to support earlier recognition of clinical deterioration.

Completion rates of bundle treatment of among patients with sepsis shock in intensive care departments of hospitals in Jiangsu Province from 2016 to 2020 years

Current clinical approaches for septic shock increasingly incorporate bundle treatment, a multi-component approach that uses a collection of tests and agents to assist in the identification and treatment of infection. The present study analyzed completion rates of 3 h and 6 h bundle treatment among patients with septic shock in intensive care units (ICUs) of hospitals in Jiangsu Province from 2016 to 2020, using data from the Jiangsu Provincial Intensive Care Medical Quality Control Center. Current approaches and factors affecting treatment completion were assessed.The completion rates of 3 h and 6 h bundle treatment in ICUs of all medical units in Jiangsu Province and in ICUs of hospitals of different levels were recorded. Analyses show that the completion rate of 3 h and 6 h bundle treatment for patients with septic shock in ICUs in Jiangsu Province increased year by year from 2016 to 2020.The completion rate of 3 h bundle treatment increased from 69.82% (3 604/5 162) to 82.47% (8 915/10 775) (all P<0.001). The completion rate of 6 h bundle treatment increased from 62.69% (3 236/5 162) to 72.54% (7 816/10 775) (all P<0.001). In addition, year by year, the completion rate of 3 h bundle treatment in ICUs in tertiary hospitals increased, from 69.80% (3 596/5 152) to 82.23% (7 375/8 969), while the completion rate of 6 h bundle treatment increased from 62.69% (3 230/5 152) to 72.18% (6 474/8 969) (all P<0.001). Completion rates in secondary hospitals also increased year by year, from 80.00% (8/10) to 85.27% (1 540/1 806) for 3 h treatment and from 60.00% (6/10) to 74.31% (1 342/1 806) (all P<0.001) for 6 h treatment. Completion rates for 3 h treatment in first-tier cities (83.99% (2 099/2 499)) and second-tier cities (84.68% (3 952/4 667)) was higher than in third-tier cities (79.36% (2 864/3 609)). The completion rate of 6 h bundle treatment gradually decreased in first-line (77.19% (1 929/2 499)), second-line (74.37% (3 471/4 667)), and third-line (66.94% (2 416/3 609)) cities (all P<0.001). The data collectively show that from 2016 to 2020, the completion rate of bundle treatment in septic shock patients in ICUs in Jiangsu Province improved significantly.

A Retrospective Study on Prevalence and Profile of Reverse Transcriptase Polymerase Chain Reaction Positive Severe Acute Respiratory Syndrome Corona Virus 2 Samples Tested in a Tertiary Care Hospital, South India

Introduction: In December 2019, the first outbreak of severe acute respiratory syndrome coronavirus 2 disease was reported in Wuhan, China, which was later re-named by the World Health Organization (WHO) as coronavirus disease 2019 (COVID-19). Severe illness was seen in approximately 20%–30% of patients needing intensive care unit intervention. Some of them presented with acute respiratory distress syndrome, Shock, acute cardiac injury, organ dysfunction, and acute renal injury. Aim: This study aims to estimate the prevalence of reverse transcriptase polymerase chain reaction (RT-PCR)-positive COVID-19 samples among the total samples tested and their profile among the positive COVID-19 samples at a tertiary care hospital, south India, and will also highlight the comorbid conditions associated with increased morbidity and mortality. Materials and Methods: Nasopharyngeal and oropharyngeal samples from suspected COVID-19 patients were collected and tested by real-time RT-PCR and the targeted genes were identified. Results: In our study, the prevalence of COVID-19 RT-PCR positivity was found to be 3.1%. Among the positive samples, males were found to be 58.2% and females were 41.8%. Symptomatic patients were less of which 17.65% were male and 7.98% were female. Among the positive patients, 83 patients had severe symptoms that needed intensive care and died of complications. The patients with comorbid conditions had diabetes as the leading cause of death. Conclusion: The present study concluded that mortality was found to be more among COVID-positive males, elderly people above 60 years of age with comorbid conditions.

Pandemic lockdown, isolation, and exit policies based on machine learning predictions.

The widespread lockdowns imposed in many countries at the beginning of the COVID‐19 pandemic elevated the importance of research on pandemic management when medical solutions such as vaccines are unavailable. We present a framework that combines a standard epidemiological SEIR (susceptible–exposed–infected–removed) model with an equally standard machine learning classification model for clinical severity risk, defined as an individual's risk of needing intensive care unit (ICU) treatment if infected. Using COVID‐19–related data and estimates for France as of spring 2020, we then simulate isolation and exit policies. Our simulations show that policies considering clinical risk predictions could relax isolation restrictions for millions of the lowest risk population months earlier while consistently abiding by ICU capacity restrictions. Exit policies without risk predictions, meanwhile, would considerably exceed ICU capacity or require the isolation of a substantial portion of population for over a year in order to not overwhelm the medical system. Sensitivity analyses further decompose the impact of various elements of our models on the observed effects. Our work indicates that predictive modeling based on machine learning and artificial intelligence could bring significant value to managing pandemics. Such a strategy, however, requires governments to develop policies and invest in infrastructure to operationalize personalized isolation and exit policies based on risk predictions at scale. This includes health data policies to train predictive models and apply them to all residents, as well as policies for targeted resource allocation to maintain strict isolation for high‐risk individuals.

The prothrombin time/international normalized ratio predicts prognosis in cardiogenic shock.

The study investigates the prognostic impact of the prothrombin time/international normalized ratio (PT/INR) in patients with cardiogenic shock. Despite ongoing improvements regarding the treatment of cardiogenic shock patients, intensive care unit (ICU)-related mortality in cardiogenic shock patients remains unacceptably high. Limited data regarding the prognostic value of the PT/INR during the course of cardiogenic shock treatment is available. All consecutive patients with cardiogenic shock from 2019 to 2021 were included at one institution. Laboratory values were collected from the day of disease onset (day 1) and days 2, 3, 4 and 8. The prognostic impact of the PT/INR was tested for 30-day all-cause mortality, as well as the prognostic role of PT/INR changes during course of ICU hospitalization. Statistical analyses included univariable t -test, Spearman's correlation, Kaplan-Meier analyses, C-Statistics and Cox proportional regression analyses. Two hundred twenty-four cardiogenic shock patients were included with a rate of all-cause mortality at 30 days of 52%. The median PT/INR on day 1 was 1.17. The PT/INR on day 1 was able to discriminate 30-day all-cause mortality in cardiogenic shock patients [area under the curve 0.618; 95% confidence interval (CI), 0.544-0.692; P = 0.002). Patients with PT/INR > 1.17 were associated with an increased risk of 30-day mortality [62% vs. 44%; hazard ratio (HR) = 1.692; 95% CI, 1.174-2.438; P = 0.005], which was still evident after multivariable adjustment (HR = 1.551; 95% CI, 1.043-2.305; P = 0.030). Furthermore, especially patients with an increment of the PT/INR by ≥10% from day 1 to day 2 were associated with an increased risk of 30-day all-cause mortality (64% vs. 42%; log-rank P = 0.014; HR = 1.833; 95% CI, 1.106-3.038; P = 0.019). Baseline PT/INR and an increase of the PT/INR during the course of ICU treatment were associated with the risk of 30-day all-cause mortality in cardiogenic shock patients.

ԿՐԾՔԱԳՈՏԿԱՅԻՆ ՄԻՋՓԱԿԵՂԱՅԻՆ ՀԱՐԹՈՒԹՅԱՆ ՊԱՇԱՐՄԱՆ (THORACOLUMBAR INTERFASCIAL PLANE BLOCK - TLIP) ԿԻՐԱՌՈՒՄԸ ՈՂՆԱՇԱՐԻ ԳՈՏԿԱՅԻՆ ՀԱՏՎԱԾՈՒՄ ԿԱՏԱՐՎՈՂ ՎԻՐԱՀԱՏՈՒԹՅՈՒՆՆԵՐԻ ԺԱՄԱՆԱԿ․ ԳՐԱԿԱՆՈՒԹՅԱՆ ՏԵՍՈՒԹՅՈՒՆ

Pain management after spine surgery is challenging and usually not sufficient. Most patients suffer from severe postoperative pain. Numerous studies have demonstrated the effectiveness of various regional anesthetic techniques in postoperative pain management. In recent years, thoracolumbar interfascial plane block (TLIP) has become widely used for perioperative analgesia during lumbar spine surgeries. It is a type of ultrasound-guided plane block, during which a local anesthetic is injected into the fascial plane between the multifidus and longissimus muscles, with the aim of blocking the dorsal rami of the thoracolumbar nerves. TLIP block was first proposed by Hand et al. in 2015. The aim of this study is to review the scientific publications regarding the use of TLIP block in lumbar spine surgery in the most popular electronic databases, such as PubMed, Scopus, Google Scholar, Web of Science, and comparing lumbar spine surgeries with and without TLIP block according to the following criteria: postoperative pain intensity, postoperative analgesic requirement, intraoperative opioid use, incidence of postoperative nausea and vomiting, comparison with other regional anesthesia methods. Analysis of the reviewed literature shows that TLIP block in lumbar spine surgery reduces the requirement of perioperative analgesics, decreases the intensity of postoperative pain up to 24 hours postoperatively, reduces the frequency of postoperative nausea and vomiting, therefore, is an effective method and can be used in daily practice. At the same time, almost all researchers consider that obtained data quality is low and that more studies with a larger number of patients and a longer duration are needed to statistically confirm the obtained data. In particular, studies are needed to determine whether TLIP block is sufficiently effective compared to other regional anesthesia methods, especially erector spinae plane block (ESP), whether TLIP block reduces the incidence of chronic pain syndrome, whether it affects the duration of surgery, postoperative intensive care unit treatment and length of hospital stay, whether TLIP-block reduces intraoperative blood loss, whether it is possible to prolong and enhance the effect of TLIP block with adjuvants, in particular dexamethasone and dexmedetomidine. Thoracolumbar interfascial plane block (TLIP) is a promising method for perioperative analgesia, reduction of analgesic use and postoperative complications in lumbar spine surgery, however, further studies are needed to determine its effectiveness and optimal application methods.

Clinical and laboratory features and prognostic factors for outcome of progressive multifocal leukoencephalopathy in HIV-infected patients

Objective: To analyze clinical and laboratory features to predict the outcome of progressive multifocal leukoencephalopathy (PML) in HIV-infected patients.Materials and methods: Retrospective analysis of medical histories of HIV-infected patients with CNS lesions in 2015–2017, and dynamic monitoring of HIV patients with CNS lesions in 2018–2019, who were intensive care unit (ICU) in Infectious Clinical Hospital No. 2 of the Department of Health of Moscow.Results and discussion: A total 196 patients with encephalitis/meningoencephalitis: 124 (63%) patients with detected JCPyV in the cerebrospinal fluid (CSF) — study group (JCPyV+), 72 patients with undetectable JCPyV in CSF — comparison group (JCPyV–). Late terms of hospitalization were noted, mainly in the JCPyV+ group (mean — 58±6 days). The majority of patients had severe immunodeficiency, in the JCPyV+ group the number of patients with CD4&lt;200 cells/μl was significantly higher than in the JCPyV– group (87.8% and 75.8%, p&lt;0.05). Only 22% of patients received antiretroviral therapy (ART) prior to hospitalization. The main clinical manifestations of PML in the study were: paralysis and paresis of the limbs, speech impairment, cognitive disorders in combination with cerebral symptoms in the absence of meningeal signs. In 87.8% patients with positive JCPyV DNA no other pathogens were detected in the CSF; in the patients without PML the detection of infectious agents in the CSF was also rare (14.3%). The disease led to the death for 78% patients in the JCPyV+ group and 72% JCPyV– group, p&gt;0.05. The chance of survival was 2.5 times higher for patients admitted to hospital less than 14 days after deterioration (OR=2.468 [95% CI: 1.244–4.898]). Patients with CD4&lt;200 cells/μL were 5.5 times more chance to die than patients with higher CD4 rates (OR=5.449 [95% CI: 2.388–12.431]). There was no relationship between the concentration of JCPyV DNA and HIV RNA in the CSF and their impact for the disease outcome.Conclusion: Survival prognosis for PML during treatment in ICU was worser for patients hospitalized after 14 days from the onset of symptoms and with CD4&lt;200 cells/μL. Early ART initiation for all HIV-positive individuals significantly reduces the number of opportunistic infections and improve life expectancy.