Objective : Decompressive craniectomy (DC) is a surgical procedure in which a portion of the skull overlying edematous and vulnerable brain tissue is removed to reduce intracranial pressure. In cases where all other treatment modalities fail, DC can be life-saving. However, this procedure is not a “panacea;” it can prolong the death process and condemn the patient to a life in need of care, with severe neurological sequelae.Methods : This multicenter, retrospective study recorded patients’ comorbidities, Glasgow coma scale (GCS), Acute physiology and chronic health evaluation II (APACHE II) and Sequential organ failure assessment (SOFA) scores, as well as relevant laboratory parameters. Patients were categorized into three groups according to the Glasgow outcome scale.Results : Among 201 patients, 41.3% expired, 33.8% survived with severe vegetative sequelae, and 24.9% had mild to moderate sequelae. Non-survivors had significantly lower preoperative and postoperative GCS scores (median 7 vs. 9, p=0.010; 3 vs. 10, p<0.001) and higher 24-hour peak glucose levels (186 vs. 164 mg/dL, p=0.009). Steroid therapy was ineffective. Preoperative GCS scores were significantly lower in patients who later developed severe sequelae compared to those with better outcomes (median 8 vs. 11, p<0.001). Postoperative GCS scores were also lower in this group (8 vs. 13, p<0.001).Additionally, APACHE II (22 vs. 18, p=0.002) and SOFA scores (4 vs. 3, p<0.001) were higher, indicating greater disease severity.Conclusion : DC can be a lifesaving procedure in selected patients with appropriate indications and appropriate timing. However, the possibility of this procedure resulting in high mortality and severe sequelae cannot be ignored. Therefore, the clinical outcomes that the patient and their families would find acceptable should be carefully considered.

Older patients now constitute a large proportion of ICU admissions, yet conventional severity scores may not adequately reflect their specific vulnerabilities. This study examined whether pre-ICU frailty, functional status, comorbidity burden and acute organ dysfunction at ICU admission were associated with 30-day all-cause mortality in patients aged ≥ 65 years, and whether the associations of geriatric vulnerability measures persisted in adjusted models that also included conventional physiology-based severity scores. In this multicentre prospective observational cohort study, 55 ICUs across 27 provinces in Türkiye enrolled consecutive eligible patients aged ≥ 65 years who had an ICU length of stay exceeding 48 h during a 1-month period. Pre-admission frailty and functional status were assessed using the Clinical Frailty Scale (CFS), FRAIL questionnaire and Katz Index of Activities of Daily Living (Katz ADL); comorbidity burden was assessed using the Charlson Comorbidity Index (CCI); and acute illness severity was assessed using the Sequential Organ Failure Assessment (SOFA), Acute Physiology and Chronic Health Evaluation II (APACHE II) and modified Nutrition Risk in the Critically Ill (mNUTRIC) scores. The primary outcome was 30-day all-cause mortality after ICU admission. Kaplan–Meier and Cox regression analyses were framed as conditional 48-h landmark analyses. Follow-up began at the 48-h landmark; observed death times were retained, and all patients alive at day 30 were administratively censored at landmark day 28. A total of 1,529 patients were included (median age, 77 years), and 30-day all-cause mortality was 33.7%. Frailty was common, with 71.2% of patients having a CFS ≥ 5. In the conventional primary Cox model, CFS (aHR 1.190 per one-point increase, 95% CI 1.129–1.255) and SOFA (aHR 1.182 per one-point increase, 95% CI 1.152–1.212) were associated with mortality. In the centre-clustered robust model, CFS (aHR 1.190, 95% CI 1.104–1.283) and SOFA (aHR 1.182, 95% CI 1.143–1.222) remained statistically significant, whereas CCI was estimated with less precision and was not statistically significant (aHR 1.034, 95% CI 0.989–1.081). The extended conventional and centre-clustered robust models including APACHE II yielded the same substantive pattern. Comparisons of organ-support therapies and ICU-acquired complications across vulnerability strata were descriptive and unadjusted. In this selected cohort of ICU patients aged 65 years or older with an ICU length of stay exceeding 48 h, pre-admission frailty and early organ dysfunction showed the most robust associations with 30-day all-cause mortality, whereas chronological age was not independently associated in the adjusted models. These findings should not be interpreted as evidence that chronological age is irrelevant, but rather that frailty and acute organ dysfunction remained associated with mortality after adjustment for chronological age in this cohort.

Background Disseminated intravascular coagulation (DIC) is a complex hemostatic disorder characterized by simultaneous thrombosis and bleeding and is frequently observed in sepsis. Traditional coagulation assays such as prothrombin time (PT) and activated partial thromboplastin time (aPTT) primarily assess the initiation of clot formation but fail to capture the dynamic balance between procoagulant and anticoagulant forces. The thrombin generation (TG) assay provides a more comprehensive evaluation of coagulation, incorporating both propagation and decay phases, and may offer additional insight into sepsis-associated coagulopathy. This study investigated the diagnostic and prognostic utility of TG parameters across graded stages of DIC in septic intensive care unit (ICU) patients.Methods In this prospective observational study, 53 adult septic ICU patients contributed 151 plasma samples obtained longitudinally. Patients were classified as non-DIC, non-overt DIC, or overt DIC according to International Society on Thrombosis and Haemostasis criteria. Standard coagulation parameters and TG profiles were measured. Associations with DIC severity were examined using cumulative link mixed models with patient-level random effects. Sensitivity analyses explored transition-specific TG behavior. ICU mortality was evaluated using multivariable logistic regression and ROC analysis.Results In univariate analyses, both conventional coagulation markers and TG parameters were associated with increasing DIC severity. In the final multivariable model, prolonged PT and aPTT, elevated D-dimer, and lower platelet count were the strongest independent predictors of DIC severity, whereas StartTail provided complementary kinetic information. Longitudinal analyses demonstrated progressive prolongation of StartTail and attenuation of reverse velocity index with advancing DIC stage and increasing SOFA scores, indicating worsening dysregulation of thrombin inactivation.Conclusion TG parameters, particularly late-phase kinetic features, reflect dynamic and stage-specific dysregulation of coagulation in sepsis-associated DIC. Although TG measures do not outperform conventional coagulation tests, they provide complementary mechanistic insight into thrombin regulation and consumptive coagulopathy. Larger multicenter studies are warranted to validate these findings.

Introduction: Hemoadsorption (HA) removes circulating inflammatory mediators and is used as an adjunct in septic shock. We assessed whether a protocol-based HA330 strategy improved early organ dysfunctions and outcomes. Materials and Methods: We performed an observational study of adults with septic shock admitted to a 59-bed mixed ICU (January 2023-June 2024). We compared outcomes of patients who were treated with HA, to those who received standard of care alone. Results: During the study period, 52 of 127 septic shock patients received hemoadsorption therapy (HA group), while 75 received standard care (control group). On ICU admission age, sex, comorbidity, APACHE II, and SOFA scores were similar. By day 3, SOFA score decreased with HA (8 [5-11] to 7 [5-9]; p<0.05) but was unchanged in controls. Vasoactive inotropic score declined in both groups, more prominently with HA. Mechanical ventilation requirement and ICU length of stay were comparable. AKI decreased from 71.2% to 46.2% in the HA but increased from 44.0% to 50.7% in the control group. Hospital stay was longer with HA (29,5 [18-47,75] vs 19 [12-30], p=0.009), whereas 28-day mortality was lower (30.8% vs 49.8%, p<0.05). Conclusions: Protocol-based early HA at high vasopressor requirements was associated with improved organ dysfunctions and reduced 28-day mortality in septic shock patients.

Traditional predictors of weaning outcomes primarily focus on acute illness severity and physiological parameters, while geriatric vulnerability domains such as frailty, functional dependence, and nutritional risk are often overlooked. Evidence regarding the incremental prognostic value of these domains for predicting weaning failure in critically ill older patients remains limited. This study aimed to evaluate the association between pre-admission frailty, functional status, comorbidity burden, and acute organ dysfunction with weaning failure in critically ill patients aged ≥ 65 years, and to compare their prognostic contribution with traditional severity scores. This study is a secondary analysis of a national, multicenter, prospective observational cohort conducted across adult ICUs in Türkiye. Consecutive ICU patients aged ≥ 65 years who required invasive mechanical ventilation for more than 24 h were included. Multivariable logistic regression was used to identify factors independently associated with weaning failure. Weaning failure was defined as the need for reintubation within 7 days after extubation, death during the weaning process, or persistent requirement for invasive mechanical ventilation at day 90. Model discrimination was assessed using the area under the receiver operating characteristic curve (AUC). A total of 647 critically ill older patients were included in the study. Weaning failure occurred in 347 patients (53.6

Amaç: Yoğun Bakım (YB) endikasyonu kalmayan hastaların ilgili servislere sevkinde yaşanan sorunlar nedeniyle bu hastaların YB’de gereksiz yatak işgal etmesi ve terminal hastalarda faydasız tedavi uygulamaları yoğun bakım ve tıp etiği literatüründe sıklıkla tartışılan konulardır. Çalışmanın amacı; ülkemizdeki YB yataklarında endikasyon dışı yatış ve tedavi durumunu ve doktorların bu duruma yaklaşımlarını anlamaktır. Gereç ve Yöntem: Çalışma 18 Ocak 2024 tarihinde gerçekleştirilmek üzere bir günlük nokta prevalans olarak planlanmış 35 sorudan oluşan (Google Survey formu) anket çalışmasıdır. Çalışma iki temel konu temelinde; yoğun bakımda endikasyon dışı yatan hasta oranı ve nedenleri ile yoğun bakımda faydasız tedavi uygulanan hasta oranı ve yoğun bakım doktorlarının bu konudaki görüş ve önerilerinin belirlenmesi olarak kurgulanmıştır. Bulgular: Çalışmaya YB’de çalışan, 127 hekim katılmıştır. Hekimlerden 58’i hastalarının %10’unun, 27’si ise; %20’sinin YB endikasyonu sonlanmasına rağmen servislere verilemediğini belirtmiştir. İlgili kliniklerde boş yatak olmaması nedeniyle, 92 hekim hasta yatışlarının 1-5 gün süreyle, 21 hekim ise; 6-10 gün süreyle uzadığını belirtmişlerdir. 50 hekiminin hastalarının %10’u, 26 hekimin hastalarının %20’si, 21 hekiminin ise; hastalarının %30’u palyatif servislere devir edilemediği için YB’de yatışı devam etmektedir. 40 hekim, palyatif servis için bekleme süresinin; 20 günden fazla olduğunu belirtilmiştir. Tüm hekimler YB’de faydasız tedaviler yapıldığı şeklinde görüş bildirmişlerdir. Hekimlerin sadece %8.7’si terminal dönem hastası olmadığını bildirmiştir. Sonuç: Yoğun bakımlarda akılcı yatak kullanımına engel olan faydasız tedavi; sorunların doğru analizi ışığında çözüm yolları ile önlenebilir bir durumdur.

Objective: The limitation or withdrawal of futile treatment is widely accepted in the intensive care and medical ethics literature. However, implementing this in clinical practice is often difficult. The aim of the study is to understand the situation of non-indicated admissions and treatments in ICU beds in our country, as well as the doctors' approaches to this issue. Materials and Methods: The study is planned as a one-day point prevalence survey consisting of 35 questions (Google Survey form) to be conducted on January 18, 2024. The study is based on two main topics: the proportion of patients admitted to intensive care unit (ICU) without indication and the reasons for it, and the proportion of patients who receive futile treatment in the ICU, as well as identifying the views and recommendations of ICU doctors on these issues. Results: A total of 127 doctors working in the ICU participated in the study. Among the participants, 58 reported that 10% of their patients, and 27 reported that 20% of their patients could not be transferred to the wards despite no longer needing ICU care. Due to the lack of available beds in the relevant clinics, 92 physicians stated that patient stays were extended by 1-5 days, and 21 physicians reported an extension of 6-10 days. In cases where transfer to palliative care services was not possible, 50 physicians indicated that 10% of their patients, 26 physicians indicated that 20%, and 21 physicians indicated that 30% of their patients remained in the ICU. Forty physicians reported a waiting time of more than 20 days for palliative care service. All physicians stated that futile treatments were being administered in the intensive care unit. Only 8.7% of the physicians reported that the patient was not in the terminal stage. Conclusion: Useless treatment that prevents rational bed use in intensive care units; It is a preventable situation with solutions in the light of correct analysis of the problems.

Background: Drug-induced liver injury (DILI) is a significant complication in intensive care unit (ICU) patients, driven by polypharmacy and critical illness. This study aimed to investigate the incidence, clinical characteristics, implicated agents, and outcomes of DILI in ICU patients. Methods: This retrospective, cross-sectional study included patients with abnormal liver function tests admitted to a tertiary ICU between October 2023 and October 2024. Patients with viral, alcoholic, autoimmune, tumor-related, or other non-drug-related liver diseases were excluded. Data on demographics, clinical scores, medications, and outcomes were analyzed. Causality was assessed using the RUCAM scale. Results: Among 475 ICU patients, 16 cases (9.89%) were identified as DILI. The mean age was 47.1 +/- 23.6 years; 43.8% were female. Antibiotics were the most frequently implicated agents (62.5%), followed by anticoagulants and antipsychotics. The predominant pattern of liver injury was hepatocellular (81.3%). DILI developed approximately 9.5 +/- 5.2 days after ICU admission. Mortality among DILI patients was 56.3%, emphasizing the critical nature of hepatotoxicity in this population. Conclusion: DILI in ICU patients is strongly associated with anti-infectives, particularly beta-lactam antibiotics, and predominantly manifests as hepatocellular injury. High mortality underscores the need for vigilant liver monitoring, timely withdrawal of suspected drugs, and a multidisciplinary approach where clinical pharmacists can play a key supportive role. DILI may contribute to morbidity and mortality in critically ill patients, highlighting the importance of early recognition and proactive management.

Background: Herein, we aimed to develop and test machine learning (ML) models to predict disease severity and/or progression in hospitalized COVID-19 patients through baseline laboratory features. Methods: In this retrospective study of hospitalized COVID-19 patients admitted to a tertiary care center, we evaluated routine admission data to determine the accuracy rates of different ML algorithms: k-nearest neighbor classifier, bagging classifier, random forest (RF), and decision tree. These models were compared over three outcomes: those who needed oxygen supplementation vs. who did not on admission (Analysis 1, n: 180), those who later developed oxygen requirement vs. those who did not (Analysis 2, n: 112), and those who needed invasive mechanical ventilation vs. those who did not during hospitalization (Analysis 3, n: 164). Results: The median age of the patients was 55 (44-68) years, with males constituting 47.2% of the subjects. At admission, 37.8% of the patients required oxygen supplementation. During hospitalization, 17.5% needed mechanical ventilation, and 8.3% died. For all analyses, RF had the highest accuracy in classifying the need for oxygen supplementation on admission (89.4%) or during hospitalization (91.1%) and for invasive mechanical ventilation (92.2%). These were followed by a bagging classifier for Analysis 1 (88.3%) and Analysis 3 (91.0%) and by a decision tree for Analysis 2 (88.4%). C-reactive protein, monocyte distribution width, and high-sensitive troponin-T were the most crucial laboratory contributors to Analysis 1, Analysis 2, and Analysis 3, respectively. Conclusion: Our study showed that ML algorithms could predict the need for oxygen supplementation and mechanical ventilation during hospitalization using baseline laboratory data, suggesting a slight superiority of RF, among others.

Background:Vaccines against coronavirus disease-19 (COVID-19) have been effective in preventing symptomatic diseases, hospitalizations, and intensive care unit (ICU) admissions. However, data regarding the effectiveness of COVID-19 vaccines in reducing mortality among critically ill patients with COVID-19 remains unclear.Aims:To determine the vaccination status and investigate the impact of the COVID-19 vaccine on the 28-day mortality in critically ill patients with COVID-19.Study Design:Multicenter prospective observational clinical study.Methods:This study was conducted in 60 hospitals with ICUs managing critically ill patients with COVID-19. Patients aged ≥ 18 years with confirmed COVID-19 who were admitted to the ICU were included. The present study had two phases. The first phase was designed as a one-day point prevalence study, and demographic and clinical findings were evaluated. In the second phase, the 28-day mortality was evaluated.Results:As of August 11, 2021, 921 patients were enrolled in the study. The mean age of the patients was 65.42 ± 16.74 years, and 48.6% (n = 448) were female. Among the critically ill patients with COVID-19, 52.6% (n = 484) were unvaccinated, 7.7% (n = 71) were incompletely vaccinated, and 39.8% (n = 366) were fully vaccinated. A subgroup analysis of 817 patients who were unvaccinated (n = 484) or who had received two doses of the CoronaVac vaccine (n = 333) was performed. The 28-day mortality rate was 56.8% (n = 275) and 57.4% (n = 191) in the unvaccinated and two-dose CoronaVac groups, respectively. The 28-day mortality was associated with age, hypertension, the number of comorbidities, type of respiratory support, and APACHE II and sequential organ failure assessment scores (p < 0.05). The odds ratio for the 28-day mortality among those who had received two doses of CoronaVac was 0.591 (95% confidence interval: 0.413-0.848) (p = 0.004).Conclusion:Vaccination with at least two doses of CoronaVac within six months significantly decreased mortality in vaccinated patients than in unvaccinated patients.

Management of Crush-related Acute Kidney Injury After DisastersRecently, on February 6, 2023, a 7.8 magnitude earthquake struck southeastern Turkey and neighboring states.It has become the worst disaster ever recorded in the region, with over 40,000 deaths, and the rescue operations have not been finalized yet.This incident should stress the importance of preparedness, foresight, and organization of our disaster management system for and during natural or artificial disasters.The experiences of these mournful days are hard-learned lessons for the future.

Introduction Sepsis, defined as an increase of 2 points or more in the sequential organ failure assessment score, is a life-threatening organ dysfunction caused by the dysregulated host response to infection. Volume-conductivity-scatter (VCS) parameters of cell counters which are known as cell population data (CPD) have been suggested to be beneficial in diagnosing sepsis. We aimed to evaluate the diagnostic value of CPD parameters in sepsis in comparison to nonsystemic infection cases (NSI) and non-infectious acute and chronic inflammatory conditions. Materials and Methods We prospectively included four groups of patients" data: sepsis (n = 66), localized infection (pneumonia, n = 59), chronic inflammation (rheumatoid arthritis, n = 92) and noninfectious inflammation (coronary artery bypass graft operation, n = 56) groups, according to their clinical status and laboratory results. Samples for cell counting and serum markers were collected on the same day of culture collection. VCS parameters were measured by Unicel DxH800 Coulter Cellular Analyzer (Beckman Coulter, USA). Results Mean neutrophil volume (MN-V-NE), was highest in the sepsis group [155(149-168)] compared to the localized infection [148(140-158)], chronic inflammation [144.5(142-149)] and noninfectious inflammation [149(145.2-153.7)] (P = 0.001, P < 0.001, P < 0.001, respectively). Neutrophil volume SD (SD-V-NE) was higher in the sepsis [21(18.8-23.7)], significantly differentiating sepsis from other groups. The area under curves of procalcitonin and hs-C-reactive protein were 0.846 and 0.837, respectively, in the receiver-operating characteristic curves (ROC) . CPD combinations, (SD-V NE + SD-V LY + SD-V MO), (SD-V NE + SD-V MO), and (MN-V NE + SD-V NE + SD-C LY + SD-V MO) had greater AUC values than procalcitonin's. Conclusion VCS parameters might be promising for differentiating sepsis and non-sepsis cases. Additionally, obtaining these data routinely makes their prospects promising without any additional cost and time.

Hemoadsorption is an extracorporeal therapy that uses specialized adsorptive filters to eliminate harmful substances, such as cytokines and toxins, selectively or non-selectively from a patient’s bloodstream. In doing so, it aims to mitigate the systemic effects of severe inflammatory conditions. It represents a groundbreaking advancement in critical care medicine; its clinical applications are growing in various severe inflammatory conditions as an important adjuvant treatment to the standard of care in the last few years.

Objective: To evaluate the overseas experiences of our intensive care unit doctors and to determine out the reasons for our doctors who couldnot go and what support they wanted. Materials and Methods: The created questionnaire was delivered to the doctors via the internet. The survey consisted of three main parts. They were asked in the first part, sociodemographic characteristics; in the second part, how long they went abroad, how they choose the center, from whom they received support; in the third part, the reasons why our physicians who donot have been abroad experienced could not go, on which subject/center they want to gain professional experience, and how to get support in this regard. Results: 31.4% of the 156 participants had professional abroad experience. 55% of those who went stated that they found the center with their own efforts, and very few (13 people, 26%) stated that they received support from the education/administrative unit of the institution they worked during the admission. In academically titled physicians, the level of foreign language and the importance given to education abroad were quite high. It was determined that the frequency reading articles was correlated only with the duration of the profession. The most common reasons for physicians who couldnot get a chance to go was not being able to find a clinic/scholarship program to go to/not being informed (63.5%) and high accommodation/living fees (48.4%). Conclusion: Professional overseas experience has a high contribution to our physicians and our health system. The biggest obstacle for our physicians who cannot attend is not being able to find center/clinic to go to. We think that the institutions/associations to which they are affiliated can support this issue.

INTRODUCTION:Favipiravir (FVP) is an antiviral and used to treat COVID-19. We aimed to document the safety and adverse events associated with FVP on the outcome of COVID-19 treatment.METHODOLOGY:The study included 225 adult patients with moderate COVID-19 infection (World Health Organization scale-5). The adverse events (AEs) were evaluated using a grading scale supported by the Food and Drug Administration. Safety was assessed by the frequency of serious AEs.RESULTS:The AEs associated with FVP treatment were hepatotoxicity (87/225, 38.7%), weakness (32/225, 14.2%), nephrotoxicity (26/225, 11.6%), nausea (18/225, 8.0%), diarrhea (8/225, 3.6%), vomiting (5/225, 2.2%), and insomnia (4/225, 1.8%); rash was not detected. Hepatotoxicity was observed more frequently in patients who also developed nephrotoxicity (57.7% vs 36.2%, p = 0.03). The deceased patients were significantly older and had higher prevalence of hypertension, congestive heart failure (CHF), coronary artery disease, cancer, nephrotoxicity. and angiotensin- converting enzyme inhibitors/angiotensin receptor blocker use. While male gender (OR: 5.38 CI: 1.64-17.67) and CHF (OR: 6.8 CI: 1.92-24.74) were significantly associated with nephrotoxicity, age (OR: 1.06 CI: 1.02-1.10), cancer (OR: 3.9 CI: 1.10-14.22) and nephrotoxicity (OR: 5.5 CI: 1.74-17.74) were associated with mortality.CONCLUSIONS:Serious AEs were detected at very low levels that would not require discontinuation of treatment or any AE-related death. Since SARS-CoV-2 itself and drug interactions may differ, FVP-related AEs might vary in COVID-19 patients. Our study shows that FVP can be used safely with a low AE profile. More extensive evidence is required to evaluate the long-term AEs of FVP.

Flow and heat transfers along rough surfaces are investigated. A test facility is established, where rough surfaces generated by additive manufacturing can be tested. The computational work follows two goals. On the one hand, a computational tool is developed that can analyze the characteristics of a rough surface and generate rough surfaces with prescribed characteristics. On the other hand, Computational Fluid Dynamics (CFD) is applied for the analysis of flow and heat transfer along rough surfaces. The present focus is on the validation of turbulence models. Within this context, two alternative treatments, namely the wall functions (WF)-based approach and roughness resolving (RR) approach are assessed. Turbulence is modeled within a RANS (Reynolds Averaged Numerical Simulation) framework. All of the considered four turbulent viscosity models, using WF, showed a similar agreement with the measurements. Quantitatively, the realizable k-ε model is observed to deliver a better accuracy, in general, which is, then, also applied in RR calculations. The RR approach showed a fair qualitative performance, which was, however, quantitatively not as good as the WF approach. This is attributed to the idealized geometry on the one hand and possible limitations on the RANS turbulence modeling approach on the other hand. The analysis will be deepened in the future work.

Objective: This study aimed to define the predictors of critical illness development within 28 days postadmission during the first wave of the COVID-19 pandemic. Materials and Methods: We conducted a prospective cohort study including 477 PCR-positive COVID-19 patients admitted to a tertiary care hospital in Istanbul from March 12 to May 12, 2020. Results: The most common presenting symptoms were cough, dyspnea, and fatigue. Critical illness developed in 45 (9.4%; 95% CI=7.0%-12.4%) patients. In the multivariable analysis, age (hazard ratio (HR)=1.05, p<0.001), number of comorbidities (HR=1.33, p=0.02), procalcitonin ≥0.25 µg/L (HR=2.12, p=0.03) and lactate dehydrogenase (LDH) ≥350 U/L (HR=2.04, p=0.03) were independently associated with critical illness development. The World Health Organization (WHO) ordinal scale for clinical improvement on admission was the strongest predictor of critical illness (HR=4.15, p<0.001). The patients hospitalized at the end of the study period had a much better prognosis compared to the patients hospitalized at the beginning (HR=0.14; p=0.02). The C-index of the model was 0.92. Conclusion: Age, comorbidity number, the WHO scale, LDH, and procalcitonin were independently associated with critical illness development. Mortality from COVID-19 seemed to be decreasing as the first wave of the pandemic advanced. Keywords: COVID-19, prospective cohort, critical illness, prognosis

Hydrodynamics of wastewater, which is contaminated with helminth eggs is computationally and experimentally investigated, for laboratory conditions and for a small sewage treatment plant. In the computational analysis, the flow is mathematically modelled within the framework of a Eulerian–Lagrangian framework, where the continuous water phase is treated by an Eulerian, and the discrete particle phase (helminth eggs) is treated by a Lagrangian formulation. For turbulent flows, the Shear Stress Transport model is used to model the turbulence of the continuous phase. The effect of the latter on the discrete phase is modelled by a discrete random walk model. In modelling the momentum exchange between the phases, a special emphasis is placed upon the accurate determination of the drag coefficient for the helminth eggs. For this purpose, flow around individual eggs is analysed and laboratory measurements of other authors are inspected. Before applying these results, measurements are performed on a small sewage treatment plant using surrogate spheres, for validating the remaining aspects of the Eulerian–Lagrangian hydrodynamics modelling. Subsequently, the operation of the small sewage plant is analysed for wastewater containing helminth eggs for its optimization.

Around 900 million people in developing countries now live without access to clean drinking or industrial water.Waterborne pathogens cause particularly high death rates in children and immunocompromised people.In this context, the helminth eggs are of particular importance.Sedimentation is a widely used method for mechanical cleaning of wastewater.In order to use the sedimentation principle effectively, the sinking behavior of the particles should be known.In the case of the small sewage treatment plants, the question is more complex, as the residence times are shorter and the existing, possibly turbulent flow fields play a greater role for the movement of the pathogens.An overview on the problematic of parasites in wastewater solution methods was presented by Cornel and Kneidl [1].The aim of the present research is the development of a validated computer simulation model to determine the sinking behavior of helminth eggs and its application to predict the separation characteristics of a small sewage treatment plant with a subsequent optimization of the separation behavior of helminth eggs in this plant.Experimental and numerical investigations are carried out.The numerical work is based CFD procedures.The experiments comprise measurements on a small sewage treatment plant.Different sedimentation processes have been numerically investigated in many different areas of application by different authors [2].A possibility of a detailed numerical modeling of the separation process within a CFD framework is given by the formulation of the wastewater as a two-phase mixture, where the trajectories of the particles are calculated by a Lagrangian formulation, whereas the water is treated by an Eulerian formulation [3].In previous studies of this type, no special attention was paid to an accurate consideration of the shape of the particles.In calculating sink velocities, the well-known Stokes law was used, which is valid for spheres.However, helminth eggs have different shapes and the Stokes law is not necessarily sufficiently accurate for them.Thus, a focus of the present work is the determination and use of more accurate laws for the sink velocity (or drag coefficient) for helminth eggs, depending on their specific properties.To this purpose, the experimental data provided by Sengupta et al. [4] is taken as basis.