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The possibilities of a potential mutagenic/carcinogenic action of waste anesthetic gases in occupationally exposed anesthesia personnel have been previously reported in several studies. The aim of this study was to assess the DNA damage, reduced glutathione (GSH), and total antioxidant capacity (TAC) in anesthesia nurses. DNA damage was determined with comet assay, GSH levels were measured spectrophotometrically, and TAC was determined by using Randox kit. Anesthesia nurses (n = 40) showed increased DNA damage in terms of mean percentage of the total DNA in the comet tail compared to controls (n = 40) (p < .001). Mean TAC and GSH levels of the anesthesia nurses were significantly lower than that of the controls (p < .001, p < .05, respectively). The results of this study indicate that occupational exposure to anesthetic gases induce DNA damage, which may lead to changes in TAC and GSH levels.

We conducted a double-blinded study in 90 patients undergoing elective arthroscopic knee surgery to determine whether there is a role of inflammation in the analgesic efficacy of intraarticular piroxicam. Standardized general anesthetic techniques were used for all patients. At the end of the operation, after harvesting synovial biopsies, patients were randomized into three intraarticular groups equally. Group 1 received 25 mL saline, Group 2 received 25 mL 0.25% bupivacaine, and Group 3 received 25 mL 0.25% bupivacaine and piroxicam 20 mg. After microscopic examination of the synovial materials, the patients were divided into two subgroups, inflammation positive (I+) and inflammation negative (I-). Preoperatively and postoperatively at 1, 2, 4, and 6 h, pain levels, analgesic duration, and postoperative analgesic consumption were recorded. Analgesic duration was significantly longer in the I+ subgroup than the I- subgroup of Group 3 (P < 0.05). Pain scores at 1, 2, and 4 h postoperatively were significantly lower in the I+ subgroup than the I- subgroup of Group 3 (P < 0.05), whereas there were no significant differences among the subgroups of Group 1 and 2. We concluded that preoperative inflammation is one of the most important determinants of analgesic efficacy of intraarticular piroxicam. Intraarticular administration of piroxicam along with bupivacaine improves postoperative analgesia in synovial inflammation before surgery.

In this study, we compare the predictive value of clinical scoring systems that are already in use in patients with Coronavirus disease 2019 (COVID-19), including the Brescia-COVID Respiratory Severity Scale (BCRSS), Quick SOFA (qSOFA), Sequential Organ Failure Assessment (SOFA), Multilobular infiltration, hypo-Lymphocytosis, Bacterial coinfection, Smoking history, hyper-Tension, and Age (MuLBSTA) and scoring system for reactive hemophagocytic syndrome (HScore), for determining the severity of the disease. Our aim in this study is to determine which scoring system is most useful in determining disease severity and to guide clinicians. We classified the patients into two groups according to the stage of the disease (severe and non-severe) and adopted interim guidance of the World Health Organization. Severe cases were divided into a group of surviving patients and a deceased group according to the prognosis. According to admission values, the BCRSS, qSOFA, SOFA, MuLBSTA, and HScore were evaluated at admission using the worst parameters available in the first 24 h. Of the 417 patients included in our study, 46 (11%) were in the severe group, while 371 (89%) were in the non-severe group. Of these 417 patients, 230 (55.2%) were men. The median (IQR) age of all patients was 44 (25) years. In multivariate logistic regression analyses, BRCSS in the highest tertile (HR 6.1, 95% CI 2.105–17.674, p = 0.001) was determined as an independent predictor of severe disease in cases of COVID-19. In multivariate analyses, qSOFA was also found to be an independent predictor of severe COVID-19 (HR 4.757, 95% CI 1.438–15.730, p = 0.011). The area under the curve (AUC) of the BRCSS, qSOFA, SOFA, MuLBSTA, and HScore was 0.977, 0.961, 0.958, 0.860, and 0.698, respectively. Calculation of the BRCSS and qSOFA at the time of hospital admission can predict critical clinical outcomes in patients with COVID-19, and their predictive value is superior to that of HScore, MuLBSTA, and SOFA. Our prediction is that early interventions for high-risk patients, with early identification of high-risk group using BRCSS and qSOFA, may improve clinical outcomes in COVID-19.

In this study, we aimed to compare the intensive care unit (ICU) admission rate of hospitalized mild/moderate COVID-19 patients treated with hydroxychloroquine (HCQ), favipiravir, and HCQ plus favipiravir. Single center retrospective designed observational study conducted in Ankara City Hospital. Patients who were hospitalized between March 15, 2020 and June 1, 2020 in COVID-19 inpatient clinics with laboratory confirmed diagnosis of COVID-19 were included in the study. An inverse probability of treatment weighting (IPTW) for multiple treatment groups approach was used to balance the differences in several variables on admission. Among 2441 patients hospitalized with diagnosis of COVID-19 during the study period, 824 were eligible for the analysis. Median age of patients was 42 (18−93 years). Among all, 347 (43.2%) of the patients had mild disease, 470 (56.8%) had pneumonia. Propensity scores ranged from 0.1841 to 0.9381 in the HCQ group, from 0.03643 to 0.29885 in the favipiravir group, and from 0.03542 to 0.56184 in the HCQ plus favipiravir group. After IPTW for multiple treatment groups was applied, all the covariates in the planned propensity score had weighted standardized effect sizes below 10% which were ranged from 0.005 to 0.092. Multivariate analysis of treatment effect (adjusted effect of treatment) was indicated that there is no statistically significant difference between HCQ, favipiravir, and HCQ plus favipiravir treatment. After using combination of SMOTE and Bootstrap resampling approach, we found no statistically significant difference between HCQ and HCQ plus favipiravir groups in terms of ICU admission. However, compared with the HCQ group, ICU admission rate was statistically significantly higher in the favipiravir group. We obtained the similar results after the sensitivity analysis. HCQ with or without favipiravir treatment is associated with reduced risk of ICU admission compared to favipiravir alone in mild to moderate COVID-19 adult patients.

Introduction: We aimed to determine risk factors for nephrotoxicity and factors affecting mortality in patients who received colistin. Methodology: Critical patients who received colistin were enrolled. Pregnancy, age < 18 years, basal creatinine level > 2 mg/dL, colistin use for < 48 hours, and previous renal replacement therapy were exclusion criteria. KDIGO stages were determined according to creatinine levels. Patients were grouped as those with no acute kidney injury (Group N0) and those with acute kidney injury (Group N). Their demographic data, APACHE II and SOFA scores, treatments, and laboratory results were recorded. Results: A total of 91 patients were included: 27 in Group N0 and 64 in Group N. Demographic data were similar between groups; however, higher admission APACHE-II scores (OR:1.179, 95% CI:1.033-1.346, p = 0.015) and need for vasopressors (OR:5.486, 95% CI:1.522–19.769, p = 0.009) were found to be independent risk factors for nephrotoxicity. Higher APACHE II scores (OR:1.253, %95 CI:1.093-1.437, p = 0.001), presence of coronary artery disease (OR:7.720, % 95 CI: 1.613-36.956, p = 0.011), need for vasopressors (OR: 4.587, % 95 CI: 1.224 – 17.241, p = 0.024), hypoalbuminemia (OR: 4.721, % 95 CI: 1.088 – 20.469, p = 0.038), and higher direct bilirubin levels (OR: 1.806, % 95 CI: 1.055 – 3.092, p = 0.031) were independent risk factors for mortality. Conclusion: When use of colistin is considered in ICU patients, presence of modifiable risk factors for nephrotoxicity such as hypoalbuminemia, nephrotoxic drug administration, and presence of shock should be determined and managed to prevent nephrotoxicity.