Acta clinica Croatica
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Acta clinica Croatica · Apr 2023
Comparative StudyCOMPARISON OF TRACHEAL ASPIRATES IN THE PERIOD BEFORE AND AFTER THE START OF THE COVID-19 PANDEMIC IN THE INTENSIVE CARE UNIT IN A TERTIARY HOSPITAL.
Changes in working methods and diagnostics using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF) diagnostics that occurred after the start of the COVID-19 pandemic could show differences in the prevalence of positive microbiological samples. In a retrospective study, a total of 442 tracheal aspirates in the pre-pandemic period (Period A, 2018, 198 patients, age median 69 (57-78)) and 277 samples in the pandemic period (Period B, 2021, 147 patients, age 68 (56-77) (p=0.585) obtained after the start of the pandemic were analyzed. A total of 176 patients had at least 1 positive result. ⋯ The most frequently isolated pathogens were Acinetobacter baumannii in 86 patients from Period A and 32 patients from Period B, i.e., 43% vs. 21.7% of all positive isolates (p=0.247), followed by Pseudomonas aeruginosa in 29 patients in Period A (14.6%) vs. 7 (3%) (p=0.112) in Period B. A statistically significant increase was observed in the incidence of Enterobacterales (16.6% vs. 32.6%, p=0.002), especially Klebsiellae spp. Although overall mortality decreased in Period B, changes in the working methods and diagnostics did not result in changes in the mortality of patients whose tracheal aspirates were sampled.
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Acta clinica Croatica · Apr 2023
ULTRASONOGRAPHIC EVALUATION OF FEMORAL CARTILAGE THICKNESS IN PARTICIPANTS WITH ASYMPTOMATIC HYPERURICEMIA: A CASE-CONTROL STUDY.
The aim was to evaluate the effect, if any, of asymptomatic hyperuricemia on distal femoral cartilage thickness through musculoskeletal ultrasonography. A total of 66 participants were evaluated in this prospective, controlled study, including 33 asymptomatic hyperuricemic patients who presented at our outpatient clinic between January and April 2020, and 33 normouricemic subjects matched for age, gender and body mass index. Participants with systemic diseases affecting uric acid level such as chronic renal failure, psoriasis, gout, etc., participants using drugs that can affect uric acid level, and those with knee complaints were excluded from the study. ⋯ No correlation was noted between uric acid levels and cartilage thickness in all measurement areas in either the asymptomatic hyperuricemic or normouricemic group (p>0.05 all). We think that distal femoral cartilages seem to be thinner in participants with asymptomatic hyperuricemia. Longitudinal studies are needed to determine whether asymptomatic hyperuricemia will lead to knee osteoarthritis in individuals, although we believe that people with asymptomatic hyperuricemia should be informed accordingly in order to prevent development of potential knee osteoarthritis.
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In this study, we evaluated the relation between the presence of lymphopenia and the need of intensive care unit (ICU) or mortality. A total of 1670 COVID-19 patients were divided according to the severity of lymphopenia developing at the time of COVID-19 infection. According to the symptoms and need of ICU, the infection was classified as mild or severe. ⋯ In conclusion, we found a strong correlation between lymphopenia and COVID-19 outcomes. Lymphopenia in patients with COVID-19 was a prognostic factor in the course of the disease. Lymphopenia is an easy and inexpensive prognostic factor that can be used in the management of COVID-19 patients.
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Acta clinica Croatica · Apr 2023
Case ReportsAWAKE FIBEROPTIC TRACHEAL INTUBATION AND AT-RISK EXTUBATION IN A PATIENT WITH ANTICIPATED DIFFICULT AIRWAY DUE TO POST-TRAUMATIC ANKYLOSIS OF TEMPOROMANDIBULAR JOINTS.
In this case report we present successful airway management in a patient with predicted difficult airway using the Difficult Airway Society guidelines. Our patient presented with recurrence of severely reduced mouth opening due to post-traumatic bilateral temporomandibular ankylosis, and was scheduled for surgical resection of the mandibular articular processes. Awake fiberoptic intubation was planned. ⋯ After a two-point check of the endotracheal tube placement the patient was put under anesthesia. The surgery was uneventful. Finally, a plan with surgeons for safe extubation was made and the patient was extubated uneventfully on the next day using the airway exchange catheter in the intensive care unit.
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Acta clinica Croatica · Apr 2023
Case ReportsAIRWAY MANAGEMENT WITH RIGID BRONCHOSCOPE IN ADULT PATIENT DURING CERVICAL SPINE SURGERY: A CASE REPORT.
SCIWOCTET is a cervical spine injury (CSI) with objective signs of myelopathy, due to trauma, without evidence of ligament injury or bone fractures on x-ray and computed tomography (CT) images. It is rare, found in about 3% of patients with CSI. Perioperative manipulation of these patients may cause secondary spinal cord injury. ⋯ The selection of instruments and procedures is emphasized. Other procedures, techniques and instruments that can be used for airway management and their influence on the movement of the patient's head and neck are listed. It is concluded that rigid bronchoscopy with the application of manual in-line immobilization is suitable for emergency and elective intubation of patients with cervical spine pathology.