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    Comparison of the healthcare-associated infections in intensive care units in Turkey before and during COVID-19
    (Springernature, 2023) Sari, Sema; Arslan, Ferhat; Turan, Sema; Mengi, Tugce; Ankarali, Handan; Sari, Ahmet; Cavus, Mine Altinkaya
    BackgroundSecondary bacterial infections are an important cause of mortality in patients with coronavirus disease 2019 (COVID-19). All healthcare providers acted with utmost care with the reflex of protecting themselves during the COVID-19 period. We aimed to compare the rates of ventilator-associated pneumonia (VAP) and bloodstream infections (BSIs) in our intensive care units (ICUs) before and during the COVID-19 outbreak surges.MethodsThis multicenter, retrospective, cross-sectional study was performed in six centers in Turkey. We collected the patient demographic characteristics, comorbidities, reasons for ICU admission, mortality and morbidity scores at ICU admission, and laboratory test data.ResultsA total of 558 patients who required intensive care from six centers were included in the study. Four hundred twenty-two of these patients (males (62%), whose mean age was 70 [IQR, 58-79] years) were followed up in the COVID period, and 136 (males (57%), whose mean age was 73 [IQR, 61-82] years) were followed up in the pre-COVID period. BSI and VAP rates were 20.7 (19 events in 916 patient days) and 17 (74 events in 4361 patient days) with a -3.8 difference (P = 0.463), and 33.7 (31 events in 919 patient days) and 34.6 (93 events in 2685 patient days) with a 0.9 difference (P = 0.897), respectively. The mortality rates were 71 (52%) in pre-COVID and 291 (69%) in COVID periods.ConclusionProtective measures that prioritize healthcare workers rather than patients and exceed standard measures made no difference in terms of reducing mortality.
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    Efficacy of Daptomisin Versus Linezolid in the Treatment of Vancomycin Resistant Enterococcus Meningitis in an Experimental Rabbit Model
    (Turkiye Klinikleri, 2023) Sari, Sema; Tütüncü, Ediz; Sancak, İrem Gül; Şencan, İrfan
    Objective: Acute bacterial meningitis, which has a high rate of mortality and morbidity, has emergency therapy indication. Optimal therapy must be applied at optimal duration and optimal dosage. Carriage of vancomycin resistant enterococcus (VRE) are increasingly seen and we see VRE as the cause of postoperative meningitis. How-ever, in VRE meningitis, there is no optimal treatment regimen and the disease is evaluated on a case-by-case basis. In this study, it is aimed to contribute to a treatment plan for VRE meningitis based on the experimental meningitis model. Material and Methods: In our study, after creating a VRE experimental meningitis model, daptomycin and linezolid activity was compared with control group. Daptomycin was given 15 mg/kg at one dose, linezolid was given 20 mg/kg at 2 doses every 12 hours. Groups were compared with each other for cerebrospinal fluid (CSF) cell count, culture, protein, glucose, simultaneous blood glucose. Results: In both groups, CSF pleocytosis and biochemical response were similar. In the daptomycin group 24th hour of the treatment, CSF culture was positive in 22% of the rabbits, whereas no growth was observed in linezolid and control groups. Conclusion: As a result, there is no statistically significant difference observed between daptomycin and linezolid groups. There is not a standard treatment regimen for VRE meningitis, so we couldn’t compare the antibiotics that we use in our study with the standard regimen. Due to the lack of an established treatment regimen for VRE meningitis, it was not possible to compare the efficacy of antibiotics in our study with the standard regimen. Further research should be conducted on new antibiotics, combination therapies and intrathecal-intraventricular practices. © 2023 by Türkiye Klinikleri.
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    Our Experience with Mesenchymal Stem Cells in Patients with COVID-19
    (Galenos Publ House, 2021) Sari, Sema; MengI, Tugce; Tahta, Yahya
    Severe acute respiratory syndrome-Coronavirus-2 (SARS-CoV-2), which causes Coronavirus disease-2019 (COVID-19), has rapidly spread all over the world and has become a public health emergency. Coronavirus disease-2019 has a wide clinical spectrum, from asymptomatic infection to Acute respiratory distress syndrome, sepsis, metabolic acidosis, coagulation disorder, multi-organ failure and even death. The dysregulated and hyperimmune response to SARS-CoV-2 could possibly explain the highly variable disease manifestations and play an important role in the pathogenesis of COVID-19. Since there is no specific antiviral treatment in the treatment of COVID-19, treatments for inflammation against the virus and sharing experience are important. Mesenchymal stem cells (MSCs) have potent anti-inflammatory and immunomodulatory abilities that can migrate to damaged tissues, promote tissue regeneration, and inhibit tissue fibrosis. Today, MSCs are widely used in many clinical studies on immune-mediated inflammatory diseases such as Graft-versus-Host disease, systemic lupus erythematosus, and perianal Crohn's disease. MSC treatment in COVID-19 is a promising option. In this study, we would present four patients with COVID-19 who were treated with MSCs and who were found to be positive for real-time polymerase chain reaction tests on nasopharyngeal swab or tracheal aspirate. All patients were critically ill were followed up with mechanical ventilator due to severe hypoxemia. One patient was extubated and discharged. Other patients died. In this study, MSCs were used as salvage therapy in the late period, so benefit might not be seen. In previous studies, this treatment was used earlier and there were results showing the benefits of MSCs. Based on this study, MSCs can be a promising treatment option when used in the appropriate patient at the time.
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    Post-extubation Dysphagia and COVID-2019
    (Galenos Publ House, 2021) Yilmaz, Dilek; Mengi, Tugce; Sari, Sema
    Objective: Coronavirus disease-2019 (COVID-19) is a global pandemic that affects worldwide. Most patients who need intensive care due to COVID-19 develop acute respiratory distress syndrome and patients need long-term mechanical ventilation. This situation increases the risk of dysphagia, aspiration, and aspiration pneumonia in patients. Information about COVID-19-associated dysphagia is still limited. Thus, this study aimed to evaluate the frequency of postextubation dysphagia (PED) and its effect on clinical outcomes. Materials and Methods: Patients with COVID-19 in the adult intensive care unit (ICU) who were left on a mechanical ventilator for at least 24 h and are extubated were retrospectively screened. Gugging swallowing screen (GUSS) test was performed 24 h after extubation to evaluate swallowing function. Patients were examined in two groups as with and without dysphagia. Results: This study included 40 patients who were followed up on a mechanical ventilator and extubated due to COVID-19. According to the bedside GUSS test results, patients were divided into two groups as dysphagia group (n=24) and the non-dysphagia group (n=16). The mean age was higher in the dysphagia group (p<0.001). Re-intubation rate and ICU, and in-hospital mortality were higher in the dysphagia group (p<0.001 for all), whereas the length of stay in the ICU and mechanical ventilation time were longer (p=0.005 and p=0.001). ICU mortality was higher in patients with severe dysphagia (p=0.026). Conclusion: Our study revealed that the risk of PED increased with the age of patients with COVID-19 and PED increased the incidence of re-intubation, which was an important prognostic parameter that indicates mortality. Recognizing dysphagia with the early evaluation of swallowing in extubated patients with COVID-19 diagnosis is important to minimize the risk of aspiration pneumonia with proper nutrition, reduce the increased health cost, and prevent poor clinical outcomes.
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    The association between prognosis and sarcopenia assessed by psoas muscle measurements in elderly male patients with covid-19
    (Geriatrics Society, 2021) Polat, Musa; Salbaş, Çiğdem Samur; Sari, Sema; Doğan, Mustafa; Çam, Selim; Karadağ, Ahmet
    Introduction: Sarcopenia, which is defined as a generalized loss of skeletal muscle mass and function, is an important clinical condition, especially among elderly patients with comorbidities. This study assesses the association between prognosis and sarcopenia assessed by psoas muscle measurements in elderly male patients with coronavirus disease 2019. Materials and Methods: This study included 130 consecutive elderly male patients hospitalized with coronavirus disease 2019. The participants were followed until their time of discharge or death. The psoas muscle cross-sectional area, psoas density, and psoas muscle index measurements were performed based on a single-axial computed tomography section at the L2 vertebral corpus. The outcome measurements of the patients were determined as intensive care unit admission and mortality. Results: During the clinical course of these patients, 29.2% (38) were transferred to the intensive care unit, and 13.1% (17) died. The interclass correlation coefficients for the psoas muscle cross-sectional area and density were 0.91 and 0.93, respectively, between observers. Low psoas muscle index is significantly associated with mortality (p = 0.001), and the probability of mortality increases approximately 5–30 times as the psoas muscle index decreases. No factors were identified as being significantly associated with intensive care unit admission. Conclusion: In elderly male patients who are hospitalized due to coronavirus disease 2019, an assessment of the psoas muscle may provide additional information on the prognosis of the disease. © 2021, Geriatrics Society. All rights reserved.
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    THE ASSOCIATION BETWEEN PROGNOSIS AND SARCOPENIA ASSESSED BY PSOAS MUSCLE MEASUREMENTS IN ELDERLY MALE PATIENTS WITH COVID-19
    (Gunes Kitabevi Ltd Sti, 2021) Polat, Musa; Salbas, Cigdem Samur; Sari, Sema; Dogan, Mustafa; Cam, Selim; Karadag, Ahmet
    Introduction: Sarcopenia, which is defined as a generalized loss of skeletal muscle mass and function, is an important clinical condition, especially among elderly patients with comorbidities. This study assesses the association between prognosis and sarcopenia assessed by psoas muscle measurements in elderly male patients with coronavirus disease 2019. Materials and Methods: This study included 130 consecutive elderly male patients hospitalized with coronavirus disease 2019. The participants were followed until their time of discharge or death. The psoas muscle crosssectional area, psoas density, and psoas muscle index measurements were performed based on a single-axial computed tomography section at the L2 vertebral corpus. The outcome measurements of the patients were determined as intensive care unit admission and mortality. Results: During the clinical course of these patients, 29.2% (38) were transferred to the intensive care unit, and 13.1% (17) died. The interclass correlation coefficients for the psoas muscle cross-sectional area and density were 0.91 and 0.93, respectively, between observers. Low psoas muscle index is significantly associated with mortality (p = 0.001), and the probability of mortality increases approximately 5-30 times as the psoas muscle index decreases. No factors were identified as being significantly associated with intensive care unit admission. Conclusion: In elderly male patients who are hospitalized due to coronavirus disease 2019, an assessment of the psoas muscle may provide additional information on the prognosis of the disease.