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Introduction: Although numerous risk factors for acute kidney injury (AKI) have been identified, their cumulative impact remains unclear. This study aimed to identify perioperative risk factors for early post-transplant AKI on patients and outcomes and to predict AKI using clinical variables.Material and Methods: A single-center, retrospective cohort study involving 34 pediatric patients and 31 adults who underwent LT between 2015 and 2017.Results: AKI occurred in 16 (47%) pediatric patients during the first-week post-LT with stage 1, stage 2, and stage 3 AKI frequencies of 43.8, 50, and 6.3%, respectively. Renal replacement therapy (RRT) was initiated in 18.8% of pediatric LT patients. Preoperative liver enzymes and the etiology of liver failure are the most critical factors affecting AKI in pediatric LT patients. AKI occurred in 15 (48%) adult patients during the first-week post-LT with stage 1, stage 2, and stage 3 AKI frequencies of 43%, 21%, and 21%, respectively. The requirement for RRT was seen in 43% of adult LT patients. There were also statistical differences between the two groups regarding the number of patients with preoperative kidney dysfunction (20-80%, p=.047) and mortality rates (6-31 %, p=.047). In adult patients who developed post-LT AKI compared with those who did not develop post-LT AKI, they had significantly higher levels of serum creatinine (sCr) (1.9±1.9 mg/dL vs. 0.7±0.1 mg/dL, p=.013), were given lower amounts of crystalloids (73±32 mL/kg vs. 106±33 mL/kg, p=.018) and had lower urine output (UO) intraoperatively (11±9 mL/kg vs. 20±9 mL/kg, p=.047). There was a higher mortality rate in adult patients with post-LT AKI (89 vs. 11%, p=.003).Conclusion: The results of our study contribute to raising awareness of the potential risk factors associated with preoperative evaluation, intraoperative and postoperative close follow-up, careful anesthesia management, and early onset of post-LT AKI., Giriş: Akut böbrek hasarı (ABH) için çok sayıda risk faktörü tanımlanmış olmasına rağmen, bunların kümülatif etkileri belirsizliğini koruyor. Bu çalışmanın amacı, karaciğer transplantasyonu (KT) sonrası hastalarda ABH için perioperatif risk faktörlerini belirlemek ve bu faktörlerin sonuçlar üzerindeki erken klinik değişkenleri kullanarak ABH'yı öngörmektir.Gereç ve Yöntemler: 2015 ve 2017 yılları arasında KT uygulanan 34 pediatrik hasta ve 31 yetişkinin yer aldığı tek merkezli, retrospektif bir kohort çalışmadır.Bulgular: 16 (%47) pediatrik hastada KT sonrası ilk haftada ABH meydana geldi ve sırasıyla evre 1, evre 2 ve evre 3 ABH sıklıkları %43.8, %50 ve %6.3 idi. Pediatrik KT hastalarının %18,8'ine renal replasman tedavisi (RRT) başlandı. Pediatrik KT hastalarında preoperatif karaciğer enzimleri ve karaciğer yetmezliği etiyolojisi ABH'yi etkileyen en önemli faktörlerdir. ABH 15 (%48) yetişkin hastada KT sonrası ilk haftada meydana geldi ve sırasıyla %43, %21 ve %21'lik evre 1, evre 2 ve evre 3 AKI oluştu. Erişkin KT hastalarının %43'ünde RRT gereksinimi görüldü. Ameliyat öncesi böbrek fonksiyon bozukluğu olan hasta sayısı (%20-80, p=.047) ve mortalite oranları (%6-31, p=.047) açısından da iki grup arasında istatistiksel fark vardı. KT sonrası ABH gelişen erişkin hastalar, KT sonrası ABH gelişmeyenlerle karşılaştırıldığında, bu hastalarda anlamlı olarak daha yüksek serum kreatinin (sCr) seviyeleri vardı (1,9±1,9 mg/dL'ye karşı 0,7±0,1 mg /dL, p=.013), daha düşük miktarlarda kristalloid verilmişti (73±32 mL/kg- 106±33 mL/kg, p=.018) ve intraoperatif olarak daha düşük idrar çıkışları (UO) (11±9 mL/ kg'a karşı 20±9 mL/kg, p=.047) olduğu tespit edildi. KT sonrası ABH olan yetişkin hastalarda daha yüksek bir mortalite oranı vardı (%89'a karşı %11, p=.003).Sonuç: Çalışmamızın sonuçları, preoperatif değerlendirme, intraoperatif ve postoperatif yakın takip, dikkatli anestezi yönetimi sağlanmasının önemini vurgulamak ve KT sonrası ABH'nin erken başlaması ile ilişkili potansiyel risk faktörleri konusunda farkındalığın artmasına katkıda bulunmaktadır.

Amaç: Ortalama trombosit hacmi (MPV), nötrofil/lenfosit oranı (NLR), trombosit/lenfosit oranı (PLR), kırmızı hücre dağılım genişliği (RDW), çeşitli hastalıklarda mortalite ve morbiditeyi öngörmede etkili faktörler olarak önemli rol oynamaktadır. Bu çalışmada, yoğun bakım ünitemize kabul edildikten sonraki ilk saat içinde alınan kan örneklerini inceleyerek sağ kalan ve yaşamayan hastaların MPV, NLR, PLR ve RDW'sini değerlendirmeyi ve karşılaştırmayı amaçladık.Materyal ve Metodlar: Bu retrospektif çalışmaya Ocak 2019-Ocak 2020 tarihleri arasında 16 yataklı karma yoğun bakım ünitesinde yatan 672 hasta dahil edildi. Hastanemizin bilgisayar tabanlı veri sistemi incelenerek yoğun bakım ünitesinde tedavi gören hayatta kalan ve hayatta kalmayan hastaların hasta verileri değerlendirildi.Sonuç: Hastaların demografik parametreleri (cinsiyet), eşlik eden hastalık ve Htc, PLT, WBC, MPV ve PLR dahil laboratuvar parametreleri, hayatta kalan ve hayatta kalmayan hastalar arasında önemli ölçüde farklı değildi. RDW, albümin, CRP ve NLR çalışma grupları arasında istatistiksel olarak farklı bulundu.Tartışma: Kritik hastalarda mortaliteyi belirlemede yüksek RDW, NLR ve CRP seviyeleri diğer inflamatuar belirteçlerden daha anlamlı bulundu. Ayrıca yoğun bakım hastalarının prognozunu belirlemede albümin düzeyinin değerlendirilmesi önemli bulundu., Aim: Mean platelet volume (MPV), neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), red cell distribution width (RDW) plays important role as effective factors in predicting mortality and morbidity in various diseases. In the present study we aimed to assess and compare MPV, NLR, PLR and RDW of survived and non-survived patients by examining the blood samples taken within the first hour after admission to our intensive care unit.Methods: This retrospective study included 672 patients who were hospitalized in a mixed 16 bed intensive care unit (ICU) between January 2019 and January 2020. By examining our hospital's computer-based data system, patient data of the survived and non-survived patients who were treated in the ICU were analyzed.Results: The demographic parameters of the patients (gender), concomitant disease, and laboratory parameters including HTC, PLT, WBC, MPV and PLR were not significantly different between the survived and non-survived patients. RDW, albumin, CRP and NLR were found statistically different between the study groups.Conclusions: The elevated RDW, NLR and CRP levels were found more significant than the other inflammatory markers for determining mortality of the critically ill patients. In addition, evaluation of albumin level was found important in defining the prognosis of the intensive care unit patients.

Objectives: The need for an intensive care unit has increased during the pandemic of coronavirus disease (COVID-19). For this reason, intermediate-level intensive care units (IICUs) were established in hospitals worldwide. This study aims to evaluate the data of patients that hospitalized in IICU. Methods: Patients under treatment for COVID-19 were followed up in IICU after the negative polymerized chain reaction test. A total of 52 patients were evaluated retrospectively between August 24, 2020 and March 1, 2021. The patients were divided into two groups according to discharge status from IICU (Group 1: exitus, Group 2: transferred to clinic, or discharged home). Demographic data, comorbidities, Acute Physiology and Chronic Health Evaluation II (APACHE II), Glasgow Coma Scale (GCS), treatments and procedures, and complications were recorded. Results: Seventeen (32.7%) of 52 patients who were followed up in IICU died. Thirty-five patients (67.3%) were transferred to the clinic or discharged home. The APACHE II scores at admission to IICU were higher in Group 1 (26.11 ± 5.86) than in Group 2 (23.43 ± 6.32) but not statistically significant. GCS was statistically significantly lower in Group 1 than in Group 2 (7.82 ± 2.42 and 10.25 ± 2.58, respectively, p = 0.002). Mechanical ventilation rate (82.3%) and the need for inotropic agents (76.5%) were higher in Group 1 (p = 0,034 and p < 0.001, respectively). Tracheostomy was applied to 5 of all patients, and percutaneous endoscopic gastrostomy was performed 4 of them. Conclusions: We think that IICU created during the pandemic provides effective treatment for patients needing intensive care. We think IICU is beneficial in providing quick patient discharge in tertiary intensive care units.

Hospital-acquired infections especially those occur in intensive care units are an important source of mortality, morbidity, and cost. Plant materials have been an important source for antimicrobial agents for ages. To date, the antimicrobial activity of plant materials were generally tested using their extracts. There are only a few studies that deal with the antimicrobial activity of raw fibers and fabrics. This study aims to investigate the antimicrobial properties of raw hemp fibers and hemp fabrics that are in commercial production and compare them to the widely used cotton textiles. The antimicrobial activity was tested using the “disc diffusion method”. Hemp fiber and fabrics did not show any antimicrobial activity against 21 bacteria types. Contrary to the limited study in the literature, it was concluded that hemp fibers are not effective against nosocomial infections, but new studies with different fiber types are needed., Hastane kaynaklı enfeksiyonlar, özellikle yoğun bakım ünitelerinde ortaya çıkanlar önemli bir mortalite, morbidite ve maliyet kaynağıdır. Bitki materyalleri, çağlar boyunca antimikrobiyal ajanlar için önemli bir kaynak olmuştur. Bugüne kadar, bitki materyallerinin antimikrobiyal aktivitesi genellikle özleri kullanılarak test edildi. Ham liflerin ve kumaşların antimikrobiyal aktivitesi ile ilgilenen sadece birkaç çalışma vardır. Bu çalışma, ticari üretimde olan ham kenevir liflerinin ve kenevir kumaşlarının antimikrobiyal özelliklerini araştırmayı ve bunları yaygın olarak kullanılan pamuklu tekstillerle karşılaştırmayı amaçlamaktadır. Antimikrobiyal aktivite “disk difüzyon yöntemi” kullanılarak test edildi. Kenevir lifi ve kumaşları 21 bakteri türüne karşı herhangi bir antimikrobiyal aktivite göstermedi. Literatürdeki sınırlı çalışmanın aksine, kenevir liflerinin hastane enfeksiyonlarına karşı etkili olmadığı ancak farklı lif türleri ile yeni çalışmalara ihtiyaç olduğu sonucuna varılmıştır.

Background/Aim: Candidemia is a common cause of bloodstream infections in critically ill patients, resulting in high mortality and morbidity. This retrospective case-control study was designed to identify epidemiological characteristics and risk factors for candidemia in an intensive care unit. Methods: A total of 166 patients hospitalized in the intensive care unit between January 2013 and December 2017 were included in this case-control study. Candidemia was defined as at least one positive blood culture for Candida spp. with fever or other clinical findings consistent with infection. Patients who acquired candidemia more than 48 hours after admission represented the case group (n=83). Control group (n=83) consisted of case-matching patients who were hospitalized during the same period and did not develop candidemia. Results: In the candidemia group Candida albicans (57.8%) was the most common species, followed by Candida glabrata (13.3%) and Candida parapsilosis (12%). The rate of C. albicans decreased from 69.2% to 50% during the five-year study period. Out of 83 candidemia infections, 36 (43.4%) were associated with central venous catheters. C. parapsilosis had an increasing rate in parallel with central venous catheter-associated candidemia rates. When comparing cases and controls, in univariate analysis, Sequential Organ Failure Assessment (SOFA) score, blood transfusion, central venous catheter placement, intubation, gastrointestinal surgery and total parenteral nutrition were significantly more common in the candidemia group (P

AimCoronavirus disease 2019 (COVID-19) has caused a global pandemic and increased mortality has forced researchers to identify prognostic factors to identify patients at higher risk of mortality. In this study, we aimed to investigate the usability of Brain natriuretic peptide (BNP) as a predictor of mortality in critically ill patients hospitalized in the intensive care unit.Material and MethodThis retrospective study included 50 patients diagnosed with COVID-19 and followed in the intensive care unit. Patients with known heart failure who were found to have heart failure on echocardiography during follow-up were excluded from the study.Results The patients were divided into two groups based on their mortality status during hospitalization in the intensive care unit. These groups were found to be statistically similar in terms of chronic disease, gender and age (p>0.05). Non-survivor group had higher levels of BNP at the admission to intensive care unit when compared to survivor group (93.2 pg/mL (43.5-357.3) vs. 62.9 (25.0-147.1), p=0.004, respectively). Regression analysis revealed that higher BNP levels and lower lymphocyte counts can be used as a predictor of mortality for these patients. ROC curve analysis indicated that best cut-off value for predicting in-hospital death for BNP was 85.6 pg/mL with a sensitivity of 73.1% and a specificity of 70.8%.ConclusionsHigh BNP levels at admission to the intensive care unit can be used as an in-hospital mortality indicator in COVID-19 patients followed up in the intensive care unit., AmaçCoronavirus hastalığı 2019 (COVID-19), küresel bir pandemiye neden olmuş ve artan ölüm oranları, araştırmacıları daha yüksek ölüm riski altındaki hastaları belirlemek için prognostik faktörleri araştırmaya zorlamıştır.Biz bu çalışmada, yoğun bakım ünitesinde yatan kritik hastalarda, beyin natriüretik peptidinin (BNP) mortalitenin bir belirleyicisi olarak kullanılabilirliğini araştırmayı amaçladık.Materyal ve MetodBu retrospektif çalışmaya COVID-19 tanısı konan ve yoğun bakım ünitesinde takip edilen 50 hasta dahil edilmiştir. Bilinen kalp yetmezliği olan ve takiplerinde ekokardiyografide kalp yetmezliği saptanan hastalar çalışma dışı bırakılmıştır.BulgularHastalar yoğun bakım ünitesinde yatışları sırasındaki mortalite durumlarına göre iki gruba ayrıldı. Bu gruplar kronik hastalık, cinsiyet ve yaş açısından istatistiksel olarak benzerdi (p>0.05). Mortalite ile seyreden grup, hayatta kalan grupla karşılaştırıldığında yoğun bakım ünitesine kabulde daha yüksek BNP seviyelerine sahipti (mortalite ile seyreden grup 93,2 pg/mL (43,5-357,3) ve hayatta kalan grup 62,9 (25,0-147,1), p=0.004). Regresyon analizi, daha yüksek BNP düzeylerinin ve daha düşük lenfosit sayılarının bu hastalarda mortalitenin bir göstergesi olarak kullanılabileceğini ortaya koydu. ROC eğrisi analizi, BNP için hastane içi ölümü öngörmede en iyi eşik değerinin %73,1 duyarlılık ve %70,8 özgüllük ile 85,6 pg/mL olduğunu gösterdi.SonuçYoğun bakım ünitesinde takip edilen COVID-19 hastalarında yoğun bakıma kabuldeki yüksek BNP seviyeleri hastane içi mortalite göstergesi olarak kullanılabilir.

Aim: Infections with Candida species are an important cause of morbidity and mortality in intensive care units (ICUs). The studies about the prognostic factors related with candidemia in ICU patients are limited and lacking in our country. The aim of this study is to evaluate the epidemiology and prognostic factors for candidemia in adult patients admitted to a medical ICU.Methods: This is a retrospective cohort study. A total of 693 patients who were followed for more than 48 hours in our 16-bedded medical ICU between 2016 October-2019 March were evaluated retrospectively and 60 candidemia patients were included in the study. The patients were divided into two groups according to ICU mortality (survivor vs. non-survivor) and compared to determine possible prognostic factors among Candida infection risk factors.Results: The total incidence of candidemia was 46 per 1000 admissions. The most common fungal isolate was Candida albicans (57.5%). The 30-day mortality was 71.7% and ICU-mortality was 78.3%. There was no difference for age, gender, co-morbid diseases, SOFA and APACHE II scores, Glasgow Coma Score, immunosuppressive treatments (steroid or chemotherapy), septic shock, neutropenia, acute hepatic or renal failure, need for vasopressors, hemodialysis, erythrocyte transfusion and total parenteral nutrition between groups. No relationship was found between the time of initiation of antifungal therapy and mortality (P=0.268). Survivors had shorter ICU stay and hospital stay before ICU, and lower Charlson Comorbidity Index scores than non-survivors (P=0.039, P=0.008, P=0.02, respectively). Length of hospital stay before ICU, need for invasive mechanical ventilation and hypoalbuminemia were the prognostic factors for ICU mortality of candidemia patients (P=0.034, P=0.013, P=0.029, respectively). Conclusion: We reported the highest incidence rate of candidemia and one of the highest mortality rates in critically ill patients with candidemia. Confirming to most of the previous reports, Candida albicans (57.5%) was the most common isolate in our study. We evaluated reported risk factors for invasive candidiasis as a prognostic indicator for candidemia in ICU patients, and found that the length of hospital stay, invasive mechanical ventilation and hypoalbuminemia were prognostic indicators., Amaç: Candida türleri ile enfeksiyonlar, yoğun bakım ünitelerinde (YBÜ) önemli bir morbidite ve mortalite nedenidir. YBÜ hastalarında kandidemi ile ilişkili prognostik faktörlerle ilgili çalışmalar sınırlı sayıdadır ve ayrıca ülkemizde YBÜ'lerde kandidemi ile ilgili yeterli klinik çalışma bulunmamaktadır. Bu çalışmanın amacı, medikal bir YBÜ'ye kabul edilen yetişkin hastalarda kandideminin epidemiyolojisi ve prognostik faktörlerini değerlendirmektir.Yöntemler: Bu çalışma retrospektif kohort bir çalışmadır. 2016 Ekim-2019 Mart tarihleri arasında 16 yataklı yoğun bakım ünitemizde 48 saatten fazla takip edilen 693 hasta retrospektif olarak değerlendirildi ve 60 kandidemili hasta çalışmaya dahil edildi. Hastalar YBÜ mortalitesine göre (sağ kalan ve ölen) iki gruba ayrıldı ve Candida enfeksiyon risk faktörleri arasından olası prognostik faktörleri belirlemek için karşılaştırıldı.Bulgular: Toplam kandidemi insidansı 46 hasta/1000 başvuru olarak bulundu. En sık görülen mantar izolatı Candida albicans'tı (%57,5). Hastaların 30 günlük mortalitesi %71,7 ve YBÜ mortalitesi %78,3 olarak bulundu. Yaş, cinsiyet, eşlik eden hastalıklar, SOFA ve APACHE II skorları, Glasgow koma skoru, immünsüpresif tedaviler (steroid veya kemoterapi), septik şok, nötropeni, akut karaciğer veya böbrek yetmezliği, vazopresör ihtiyacı, hemodiyaliz, eritrosit transfüzyonu ve total parenteral beslenme bakımından gruplar arasında fark yoktu. Antifungal tedaviye başlama zamanı ile mortalite arasında ilişki bulunamadı (P=0.268). Sağ kalanlar YBÜ öncesinde daha kısa YBÜ yatış ve hastanede kalış süresine sahipti ve hayatta kalmayanlara göre Charlson Komorbidite İndeksi puanları daha düşüktü (sırasıyla P=0,039, P=0,008, P=0,02). Kandidemi hastalarının YBÜ mortalitesi için prognostik faktörler olarak YBÜ öncesi hastanede kalış süresi, invazif mekanik ventilasyon ihtiyacı ve hipoalbüminemi saptandı (sırasıyla P=0,034, P=0,013, P=0,029).Sonuç: Kandidemili kritik hastalarda en yüksek kandidemi insidans oranını ve en yüksek ölüm oranlarından birini bildirdik. Daha önceki raporların çoğunu doğrular şekilde çalışmamızda en sık Candida albicans (%57,5) izolatı saptandı. YBÜ hastalarında kandidemi için prognostik bir gösterge olarak invaziv kandidiyaz için bildirilen risk faktörlerini değerlendirdik. Bunlardan hastanede kalış süresi, invazif mekanik ventilasyon ve hipoalbüminemi prognostik birer gösterge olarak bulundu.

Severe preeclampsia, one of the hypertensive disorders of pregnancy and cardiac arrest is higher in these patients. In this letter, we aimed to present a 29-year-old, 25-week preeclamptic multiple pregnant patient who developed cardiac arrest due to idiopathic ventricular fibrillation(VF) in postpartum period. The patient, who was hospitalized in obstetrics clinic due to severe preeclampsia and albuminuria at the 24th week of pregnancy, was discharged after blood pressure regulation. One week later she readmitted to hospital with hypertensive crisis. patient underwent cesarean section. She was admitted to intensive care unit (ICU) due to development of hyperkalemia. Electrolyte imbalance was corrected. Cardiopulmonary resuscitation (CPR) was applied to the patient who developed witnessed VF during her ICU follow-up, and she was extubated with complete neurological recovery 8 hours after successful CPR. Maternal cardiac arrest (MCA) is a rare clinical condition. While the most common obstetric factors in MCAs are postpartum hemorrhage, amniotic fluid embolism, the most common non-obstetric factors are cerebrovascular accident, heart and respiratory failure. Early detection and effective management of MCA can improve maternal prognosis, Gebeliğin hipertansif bozukluklarından ağır preeklampsidekalp durması daha fazladır. Bu yazıda, postpartum dönemde idiyopatik ventriküler fibrilasyona (VF) bağlı kardiyak arrest gelişen 29 yaşında, 25 haftalık preeklamptik çoğul gebe hastayı sunmayı amaçladık. Gebeliğinin 24. haftasında şiddetli preeklampsi ve albuminüri nedeniyle kadın doğum kliniğine yatırılan hasta tansiyon regülasyonu sonrası taburcu olup bir hafta sonra hipertansif krizle hastaneye yeniden başvurdu. Hastaya sezaryen uygulandı. Hiperkalemi gelişmesi nedeniyle yoğun bakım ünitesine (YBÜ) yatırılan hastanın elektrolit dengesizliği düzeltildi. Yoğun bakım takibinde tanıklı VF gelişen hastaya kardiyopulmoner resüsitasyon (KPR) uygulandı ve başarılı KPR'den 8 saat sonra tam nörolojik iyileşme ile ekstübe edildi.Maternal kardiyak arrest (MCA) nadir görülen bir klinik durumdur. MCA'larda en sık obstetrik faktörler doğum sonu kanama, amniyotik sıvı embolisi iken, obstetrik olmayan faktörler ise en sık serebrovasküler olay, kalp ve solunum yetmezliğidir. MCA'nın erken tespiti ve etkili yönetimi anne prognozunun iyileşmesine katkıda bulunur.

Amaç: Sepsis ve ilişkili bozulmuş inflamatuar yanıt, çoklu organ disfonksiyonuna ve sonunda ölüme yol açabilir. HMGB1, nekrotik hücreler tarafından pasif olarak salınır ve inflamatuar hücreler tarafından aktif olarak salgılanır ve hücre dışı bir sinyal molekülü görevi görür. Bu çalışmanın amacı, sepsis tanısı alan hastalar ile sağlıklı kontroller arasında serum HMGB1 düzeylerini karşılaştırmaktır.Yöntem: Çalışmaya Gaziantep Medical Park Hastanesi Yoğun Bakım Ünitesinde 2018-2019 yılları arasında tedavi gören sepsisli hastalar ile aynı hastanenin dahiliye polikliniğine rutin kontrol için başvuran herhangi bir hastalığı olmayan sağlıklı bireyler alındı. Hastalardan (tedavinin başlangıcından hemen önce) ve kontrol deneklerinde HMGB1 seviyeleri Bio-Techne kitleri (NBP2-62766) kullanılarak nicel olarak belirlendi. Tüm istatistiksel analizler SPSS for Windows 15.0 yazılım paketi kullanılarak yapıldı. Bulgular: Araştırmanın örneklemini 36 hasta (14 (%38,9) kadın ve 22 (%61,1) erkek) ve 35 sağlıklı gönüllü olmak üzere toplam 71 katılımcı oluşturmuştur. Hastaların yaş ortalaması 70,97±14,72 yıl (dağılım 43-91) idi. HMGB1 değişkeni normal bir dağılım izlemediğinden, hasta ve kontrol grupları arasındaki fark Mann-Whitney U testi kullanılarak analiz edildi ve bu fark istatistiksel olarak anlamlı bir grup arası fark ortaya koydu (p

Objective: In this study, we aimed to evaluate the relationship between laboratory electrolyte disturbances and drugs taken in poisoning cases who applied to the Emergency Department and took drugs for suicidal purposes.Materials and Methods: This study is a retrospective study. Patients aged 18 years and older who were diagnosed with drug poisoning in the Adult Emergency Clinic of Okmeydanı Training and Research Hospital Emergency Medicine Clinic were included in the study. Data analysis was done in SPSS 15.0 program. The significance level was taken as p0.05). Conclusion: According to our suicidal study findings, the amount of drugs taken by our patients is not correlated with their blood levels. Although more than half of our patients have taken toxic doses of the drugs, most of the poisonings are mild and our results can not be generalized to severe poisoning cases.

Drug-induced QT prolongation with T wave inversion is a complex regulatory and clinical problem due to the rarity of this potentially fatal adverse incident. A 68-year-old female patient was receiving piperacillin/tazobactam therapy for a complicated urinary tract infection. She has had normal ECG findings before the antibacterial therapy. After the treatment, the patient worsens due to long QT which is predisposed to torsades de pointes. As a result of the researches, it was understood that the cause of long QT was piperacillin/tazobactam. We aimed to present a rare case in which we detected drug-induced QTc prolongation with piperacillin/tazobactam in clinical practice.

Syncope is a common complaint in emergency clinics, but the symptoms of syncope are quite comprehensive. In this study, we are going to present a case of a non-parasitic giant liver cyst that caused compression of the inferior vena cava with the right atrium in a 47-year-old female patient with a history of autosomal dominant polycystic kidney disease who applied to the emergency department due to syncope. In the examinations performed in the emergency department, we detected a giant liver cyst pressing on the inferior vena cava, right atrium, and ventricle of the heart, which prevents venous return. Sclerotherapy with catheterization was applied to the non-parasitic giant liver cyst and the drainage catheter was kept in the cyst cavity for one week to prevent an early recurrence.

In adult polycystic kidney patients, heart involvement is frequently observed in the progressing process of the disease, as well as the pathologies created in various other organs. Among others, left ventricular hypertrophy and mitral valve prolapse are generally observed. A 42-year-old female patient, receiving dialysis due to chronic renal failure resulting from autosomal dominant polycystic kidney disease, was admitted to the cardiology outpatient clinic with complaints of high blood pressure, dyspnea and abdominal pain. During clinical examinations, a cyst was detected in the tricuspid valve on echocardiography. In this case study, we aimed to present a patient with a cyst on the tricuspid valve, which has not been previously encountered in adult polycystic kidney patients.

Background: Hospital-acquired pneumonia (HAP) is an important cause of mortality and morbidity among hospital-acquired infections. Vitamin D (25[OH]D) plays a role as an anti-inflammatory, immunomodulatory, and antimicrobial agent in infections. There are limited studies on the long-term mortality prediction of 25(OH)D deficiency in HAP and the findings are controversial. In this study, our primary aim was to investigate the role of 25(OH)D level measured during hospital admission as an independent risk factor for one-year mortality in HAP patients requiring intensive care.Materials and Methods: The retrospective study included patients that were diagnosed with HAP and admitted to the intensive care unit (ICU) between 2014 and 2018. Relationship between pretreatment 25(OH)D level and one-year independent mortality was evaluated. Vitamin D deficiency was defined as a 25(OH)D level of

Background/Aim: COVID-19 is a serious disease, primarily affecting the respiratory system. The disease spreads from person to person and has become a global health problem of great concern worldwide. The aim of this study was to compare the clinical and laboratory characteristics and the mortality rates of suspected and confirmed COVID-19 cases admitted to the intensive care unit with severe pneumonia. Methods: A retrospective case-control study examination was made of 397 patients diagnosed with suspected or confirmed COVID-19 who were followed up in the intensive care unit (ICU) of Afyonkarahisar Health Sciences University Medical Faculty Hospital between 20 March 2020 and 31 December 2020. The cases were compared in respect of demographic, clinical and laboratory characteristics, prognosis, and mortality rates. Results: 397 patients comprised of 37 (9.3%) with suspected COVID-19 and 360 (90.7%) confirmed COVID-19. No difference was determined between the suspected and confirmed cases in respect of age, gender, and comorbidities (P

Dünya Sağlık Örgütü tarafindan pandemi olarak ilan edilen COVID-19 enfeksiyonu birincil olarak solunum sistemini etkiliyor gibi görünse de gastrointestinal system semptomlarının önemi ve tanınmasi giderek artmaktadir. Olgumuzda COVID-19 pnömonisi ile birlikte akut pankreatit bulgulari ile başvuran bir hastayı sunmayı amaçladik. Hipertansiyon ve koroner arter hastalığı olduğu bilinen 75 yaşinda kadın hasta, kuşak tipi epigastrik ağri, bulanti ve nefes darliği şikayeti ile acil servise başvurmuştur. Laboratuvar değerleri ve görüntüleme yöntemleri ile akut pankreatit tanısı konulan hasta, COVID-19 testinin pozitif çikmasi ve oksijen ihtiyaci nedeniyle yoğun bakima yatırılmıştır. Pankreatit için herhangi risk faktörü olmayan hastada COVID-19 enfeksiyonu ile korele pankreatit görülmüştür. Bu olgu, COVID-19'un yeni bir viral pankreatit etkeni olabileceği veya var olan bir pankreatitin şiddetini artirabileceği veya bunlardan bağimsiz olarak otoimmüniteyi tetikleyebileceği hipotezlerini düşündürmektedir. Bu görüşü desteklemek için COVID-19 hastalari üzerinde çok sayida çalişmaya ihtiyaç vardir., Although COVID-19 infection, declared as a pandemic by the World Health Organization, seems to affect the primary respiratory system, the importance and recognition of gastrointestinal symptoms are gradually increasing. In our case, we aimed to present a patient who presented with signs of acute pancreatitis concurrent with COVID-19 infection. A 75-year-old female patient, known to have hypertension and coronary artery disease, was admitted to the emergency department with the complaint of generation-style epigastric pain , nausea and dyspnoea. The patient, who was diagnosed with acute pancreatitis by laboratory values and imaging methods, was taken to intensive care due to positive COVID-19 test and oxygen demand. Pancreatitis was seen with COVID-19 infection in the patient without risk factors for pancreatitis.This case suggests hypotheses that COVID-19 could be a new viral pancreatitis agent or increase the severity of an existing pancreatitis or trigger autoimmunity independent of them. numerous studies on covid-19 patients are needed to support this view.

The aim of this study was to assess vitamin D serum levels in autoimmune thyroid disease, Hashimato thyroiditis in the Turkish population. the subjects with Hashimato thyroiditis (HT, n=67, mean age 45.1±10.9,F/M-61/6), control subjects (mean age 42.1±15.7, n=29, F/M-26/3) were recruited for the study. Thyroid function tests, thyroid antibodies (AntiTg, AntiTPO, TSHRAb), ultrasound features, demographic and antropometric variables were recorded. Vitamin D level was not different between the HT and the control groups (53.1±24.7 nmol/L and 54.1±19.8 nmol/L, as mean, respectively, p = 0.482) in the HT group, 35.8% of subjects had vitamin D insufficiency, only 16.4% of subjects with HT were vitamin D sufficient. There was no significant difference between the HT and the control groups according to the vitamin D classification status (p = 0.666). Vitamin D levels were significantly higher in the subjects who were taking replacement compared to subjects who were not (58.7 ± 26.0 vs. 46.0 ± 23.3, as mean, respectively, p = 0.033). There was no significant correlation between vitamin D levels and TgAb and TPOAb levels in HT group (p = 0.754 r = -0.039, p = 0.134 r = -0.290, respectively). in both HT and control groups, vitamin D levels were significantly correlated only with the fT4 levels (p

Gastric cancer comprises 10% of all cancers in the world and is rarely seen before the age of 30. Different genetic interactions or molecular changes like e-cadherin, P16, APC, c-erb B2, c-met, ras, or c-myc have been described in the pathogenesis of the disease. MiRNAs play critical roles in various biological processes such as cell proliferation, cell differentiation, apoptosis, repairing of DNA damage, angiogenesis, stress response, and stem cell division. The aim of this study is to investigate the relationship between miRNA gene expressions and gastric cancer. Method: Sixty-four patients with gastric cancer diagnosed consecutively in our pathology laboratory and 30 consecutive participants with normal gastric tissue, as a control group, were included in our study between 2011 and 2013. Total miRNAs were obtained by using genomic miRNA extraction kit (QIAGEN Sample & Assay Technologies, Hilden, Germany) after the samples had been deparaffinized. MiR-21, 107, 141, 150, 192, 202, 218, 331 gene expressions were evaluated by using real time-PCR (RT-PCR) from the whole miRNA. Results: MiR-331 was downregulated in the stage 2 patients and the rest of the miRNAs were significantly upregulated (p < 0.001). All miRNAs were significantly upregulated in the stage 3a patients (p < 0.001). In the antrum localized tumors, miR-107, -150, -202, -218, and -331 were significantly upregulated, whereas miR-21, -192 were statistically downregulated (p < 0.05). In the cardia localized tumors, miR-21 (p > 0.05) was downregulated and miR-107, -150, -202, -218, and -331 were upregulated (p < 0.05) Different gene expressions of miRNAs according to the different localizations of gastric cancer and different stages suggest that it can be tumor marker to predict the stage and localization of gastric cancer. [Med-Science 2019; 8(1.000): 255-9]

GİRİŞ VE AMAÇ: Bası yaraları, yoğun bakım ünitesinde (YBÜ) sık görülen, hastanede kalış süresini, maliyeti ve ölüm oranını artıran öncelikle önlenmesi gereken ciddi bir sağlık sorunudur. Bu çalışma, bası yarası prevalansımızı ve gelişimimizi etkileyebilecek risk faktörlerini belirlemek amacıyla yapılmıştır.YÖNTEM: Anestezi Yoğun Bakım Ünitesinde 1 Haziran 2019 ile 31 Aralık 2019 tarihleri arasında altı ay süreyle tedavi gören hastaların bası yarası verileri incelendi. Bası yarası olan hastaların demografik özellikleri, hastanede yatış tanıları, bası yarası risk faktörleri, yerleşim yerleri ve evreleri kaydedildi.BULGULAR: Altı aylık dönemde takip edilen hasta sayısı 275 idi ve hastaların 52'sinde bası yarası vardı (% 18.9). Hastaların 40'ı 65 yaş ve üzerindeydi ve ileri yaş en önemli risk faktörü olarak bulundu (p, INTRODUCTION: Pressure sores are a serious health problem that is common in the intensive care unit (ICU), increasing the length of hospital stay, cost and mortality rate, and should be prevented first. This study was conducted in order to determine the risk factors that may affect our pressure sore prevalence and developmentMETHOT: The pressure sore data of the patients treated in the Anesthesia Intensive Care Unit for six months between June 1, 2019 and December 31, 2019 were examined. The demographic characteristics, hospitalization diagnoses, pressure sore risk factors, locations and stages of the patients with pressure sores were recorded.RESULTS: The number of patients followed up during the six-month period was 275, and 52 of the patients had pressure sores (18.9%). Forty of the patients were 65 years and older, and advanced age was found to be a significant risk factor (p

Aim: This study was designed to analyze demographic, clinical and laboratory characteristics beside risk factors that affect the mortality rate of patients hospitalized in ICUs with diagnosis of CNS infection. Methods: Patients that have been hospitalized at ICU on pre-CNS infection were retrospectively studied. Beside the clinical laboratory characteristics of the patients, mortality rate and risk factors that affect the mortality were recorded to be analyzed later. Results: Following the evaluation of 118 ICU patients who were suspected to have CNS infection, 62 of them, with full diagnosis of CNS infection, were included in the study. Bacterial meningitis was the diagnosis for 40 (66%) of these patients while 18 of the total (30%) was diagnosed with viral encephalitis and 3 of them (4%) was diagnosed with tuberculous meningitis. When these factors were investigated in a multivariable study, age and time from the onset of symptoms to hospital admission were independent risk factors (CI: 1,098(1,031-1,169), 1,614(1,037-1,278).Conclusion: The mortality rate of the patients that were subjects of the study was 52,5%. Age and time from the onset of symptoms to hospital admission were independent risk factors that affect the mortality.

Purpose: The effect of nutritional status on in-hospital mortality in patients with coronavirus disease 2019 (COVID-19) is unclear. We aimed to analyze the relationship between nutritional status score (CONUT) and prognostic nutritional index (PNI) and in-hospital mortality in COVID-19 infection.Materials and Methods: We included 187 patients with COVID-19 between 11 March-10 May 2020. The CONUT and PNI scores were calculated using the laboratory results. The groups were divided into survival and in-hospital mortalityResults: The mean age of the patients was 66.2±15.8 years (55.3% male). The mortality rate was 20.8% (n=39). The median PNI scores was significantly lower and the median CONUT score was significantly higher in the mortality group. Multivariate regression analysis showed that PNI and CONUT were independent predictors of mortality. ROC curve analyses showed that CONUT had a better performance than PNI to predict in-hospital mortality.Conclusion: In COVID-19 patients, CONUT and PNI scores were independently associated with in-hospital mortality, with CONUT presenting a better performance than PNI., Amaç: Koronavirüs hastalığı 2019 (COVID-19) tanısı nedeniyle yoğun bakım ünitelerinde yatan hastaların beslenme durumunun hastane içi mortaliteye etkisi belirsizdir. Çalışma, COVID-19 enfeksiyonu hastalarında iki objektif nutrisyonel indeksler olan controlling nutritional status score (CONUT) ve prognostic nutritional indeksi (PNI) nin hastane içi mortalite ilişkisini analiz etmeyi amaçladı. Gereç ve Yöntem: Çalışmaya 11 Mart-10 Mayıs 2020 tarihleri arasında yoğun bakım ünitelerinde yatan 187 COVID-19 hastası dahil edildi. Demografik ve klinik verileri kaydedildi. CONUT ve PNI skorları laboratuvar sonuçlarından hesaplandı. Hastalar mortalite grup ve ve non-mortalite grup olmak üzere iki gruba ayrıldı. Bulgular: Hastaların ortalama yaşı 66.2±15.8 yıl (% 55,3 erkek), ölüm oranı % 20,8 (n = 39) idi. Mortalite grubunda Medyan PNI skorları anlamlı olarak daha düşük ve medyan CONUT skorları anlamlı olarak daha yüksek belirlendi. Çok değişkenli regresyon analizinde, PNI ve CONUT un mortalite ile bağımsız olarak ilişkili olduğunu belirlendi. Ayrıca ROC eğrisi analizlerinde, CONUT un hastane içi mortaliteyi tahmin etmede, PNI'den daha iyi bir performansa sahip olduğunu belirlendi. Sonuç: COVID-19 hastalarında, CONUT ve PNI skorlarının hastane içi mortalitede bağımsız prediktörler olduğunu ve CONUT'un PNI'dan daha iyi bir performansa sahip olduğu belirlenmiştir.

Aim: The COVID -19 outbreak was first seen in Wuhan, China\'s Hubei province. Lung infections caused by COVID-19; It can progress to severe ARDS (acute respiratory distress syndrome) with a high mortality.For ARDS patients, methylprednisolone (1-2 mg / kg per day) is recommended to be as short as possibleMethods:All patients with a diagnosis of covid-19 over the age of 18 who were hospitalized in the pandemic intensive care unit between March 2020 and September 2020 were retrospectively screened.Patients; demographic data, hospitalization APACHE II scores, length of stay in hospital and intensive care, laboratory values (d-dimer, creatinine, CRP (C reactive protein)), culture results, mortality and morbidity, mechanical ventilator needs. On the first day of intensive care admissions, methylprednizalone was added to the treatment intravenously at 0.5 mg/kg/day for 5 days.Results:A total of 201 patients hospitalized in adult level 3 intensive care were included in the study. All patients were PCR positive. 44.8% of the patients were female (n: 90), 55.2% were male (n: 111). Blood, urine and ETA cultures; there was no statistically significant relationship between gender, IMV need, mortality and prednol use.Conclusion: COVID-19 is a viral infectious disease that manifests mainly as fever and pneumonia. Corticosteroid therapy; in addition, it includes the following risks: hyperglycemia, poor wound healing, psychosis, pancreatitis, and prolonged muscle weakness in impaired functional status in a meta-analysis published in 2012, nine randomized controlled trials, 1001 patients were included. Consequently, the use of corticosteroids did not decrease mortality.

With its growing application in neurological and psychiatric diseases, valproic acid overdose due to acute and chronic use has been causing emergency admission. Asymptomatic cases of hyperammonemia may be found in valproic acid poisoning ranging from central nervous system depression to coma. While supportive therapy is adequate, in most cases active charcoal, levocarnitine supplementation, and treatment with naloxane and hemodialysis, when needed, can also be used. In the case study reported in this paper, we aimed to focus at bringing awareness to the use of levocarnitine in asymptomatic patients with valproic acid poisoning accompanied by hyperammonemia.

Objectives: Awareness of chronic kidney disease is important for compliance to treatment before the disease progresses to advanced stages. Low patient awareness causes the disease to advance to end-stage renal failure requiring high cost dialysis and kidney transplantation treatments. The objective of this study is to measure the awareness of chronic kidney disease in patients receiving hemodialysis and to assess the correlation of patient awareness with quality of life and depression. Additionally, this study assessed the importance of patient monitoring.Study design: This study is an evaluation and analysis study.Material & Methods: A total of 213 hemodialysis patients from 7 centers in Giresun were enrolled in this study. Awareness, factors affecting awareness, quality of life (SF-36) and the Beck depression index of chronic kidney disease in patients receiving hemodialysis treatment.Results: Of patients, 71.4% (n=152) were monitored by nephrology, 43.2% (n=92) were monitored by dieticians and 10.8% (n=23) were receiving psychological support. The awareness points of patients monitored by dieticians is significantly high compared with that of not under the control of dieticians. Also, the awareness points of patients monitored by nephrology is significantly lower compared with the patients not monitored by nephrology. There was no significant difference between awareness points of those who were receiving psychological support compared to those who were not.Conclusions: Consultations with dieticians may provide positive support to increase the disease awareness of hemodialysis patients. Increasing disease awareness does not create a positive or negative situation in terms of depression and quality of life.

Aim: Percutaneous dilatation tracheotomy in our clinic; It is opened using the advantages and methods of Griggs (GWDR) and Ciaglia Blue Rhino (CBR). We wanted to share our one-year experience with you.Method: In the study that we retrospectively examined tracheotomies performed in adult intensive care in 2019-2020; Demographic data of patients, SOFA scores, intensive care, tracheotomy, intubation days, complications, mortality and morbidity were recorded.Results: A total of 50 patients, 33 females, 17 males, were included in the study. The mean age is 65,54 ± 15,95. BMI was 26,94 ± 2,75. Ciaglia was used in 22 patients and Griggs method was used in 28 patients. Tracheotomy opening day is 10,45 ± 1,27. Griggs method; It was found to be significantly higher in terms of complications (6 minor bleeding, 1 emphysema, 1 lack of ventilation) (p = 0,001). Mortality (independent of tracheotomy method and complications) was significantly higher in the Griggs method (p = 0,005).Conclusion: Except for minor differences, no significant difference was found between both GDWR method and CBR method in the study.

Objectives: Although the prognosis is good in the vast majority of patients who are diagnosed with COVID-19, there are cases in which Acute Respiratory Distress Syndrome (ARDS) and multiple organ failure occur rapidly and result in death in a short time. It has been reported that severe clinical presentation is caused by cytokine release syndrome, and studies are currently conducted on treatments to reduce mortality in these patients. There are studies reporting the positive effects of anti-Human IL-6 Receptor Monoclonal Antibody, tocilizumab (TCZ), which specifically inhibits the functions of IL-6, in cases with cytokine storm. Data on TCZ use in intensive care are very limited. Methods: The medical records of 20 patients diagnosed with COVID-19 who were treated with standard treatment and TCZ in the ICU were retrospectively reviewed. Results: Twenty patients were included in the review. Nine (45%) received TCZ. The median length of stay in the ICU was 20 days in the TCZ group, and 14 days in the standard treatment group (p = 0.21). Mortality rate was 22.2% in TCZ group and 45.5% in the standard treatment group (p = 0.27). Conclusions: At day 28, mortality rate and clinical improvement was not statistically different in patients receiving standard treatment with TCZ and patients in standard treatment group. Additional data are needed to understand the eficacy and safety of TCZ.

Study ObjectivesKnow the result of disease severity and clinical results in community-acquired pneumonia (CAP) are preconditions for treatment options and management for health care resources. Various scoring systems as CURB-65 and SMART-COP have been developed to facilitate these awareness. We aimed to investigate the relationship between these two scoring systems with procalcitonin level in the diagnosis of CAP.MethodsStudy included hospitalized patients diagnosis CAP that had been admitted to the emergency department between 01.01.2015 - 12.31.2015. CURB-65 and SMART-COP scores were calculated. We collected measured procalcitonin levels. As described previously during the study, patients who had 2 and over values for CURB-65 and who had values 3 or more for SMART-COP were classified as high risk and groupings were structured according to these values.ResultsThe study was conducted on a total of 124 cases. 72 of the cases had a CURB-65 score of 2 or more and 49 of the cases had a SMART-COP score of 3 or above. The cases’ procalcitonin levels which had 2 ng/ml or above scores for CURB-65 had higher statistical significance than the cases that had 2 or less scores for CURB-65 (P: 0,004; p

Acute Respiratory Distress Syndrome (ARDS) is a life-threatening diffuse inflammatory condition in the lungs and result in the oxygen treatment-refractory hypoxemic respiratory failure. ARDS is not a disease and is the result or complication of an underlying disease. COVID-19 pneumonia-related ARDS is a specific condition with unique phenotypes. Although patients had very severe hypoxemia in the early stages of respiratory distress due to COVID-19 disease, there was relatively well-preserved lung compliance. This phenotype is named as “atypical ARDS” or “ARDS type L”. In advanced stage, some patients (20-30%) can return to a clinical picture more characteristic of typical ARDS progressively. This phenotype is called "typical ARDS" or "ARDS type H". Different types of ARDS that develop due to COVID-19 pneumonia require different ventilation strategies, depending on the underlying pathophysiology. In patients with early-stage atypical ARDS phenotype higher TVs and lower PEEP may be preferred, as opposed to the lung protective mechanical ventilator strategy. Nowadays, in the typical ARDS phenotype, the lung protective ventilation strategy used in classical ARDS is widely preferred. Refractory patients (a small number of patients) need to additional applications which are including prone ventilation and exorcoral membrane oxygenation (ECMO).

Amaç: Diyaliz gerektiren akut böbrek hasarı yoğun bakım ünitelerinde yüksek mortalite ve diyalize bağımlı kronik böbrek hastalığı gibi olumsuz sonuçları ile ilişkilidir. Bu retrospektif çalışma günümüz yoğun bakım pratiğinde diyaliz gerektiren akut böbrek hasarının klinik özelliklerini ve renal replasman tedavi yöntemlerini tanımlamayı amaçlamıştır.Yöntemler: Bu retrospektif kohort çalışma, bir üniversite hastanesinin 20 yataklı üçüncü basamak yoğun bakım ünitesinde 2011-2017 arasında gerçekleştirilmiştir. Toplamda, renal replasman tedavisi uygulanan 145 diyaliz gerektiren akut böbrek hasarı hastası tanımlanmıştır. Diyaliz gerektiren akut böbrek hasarı hastalarının hastane kayıtları demografi, tıbbi öykü, klinik özellikler, renal replasman tedavisi detayları ve ısa dönemli sonuçlar için retrospektif olarak analiz edilmiştir. Bulgular: İncelenen 1689 hastanın 145’inde diyaliz gerektiren akut böbrek hasarı mevcuttu. Dahil edilen hastaların ortanca yaşı 73 idi. septik etiyoloji, diyaliz gerektiren akut böbrek hasarı gelişiminde en sık şüphelenilen nedendi. Elli iki hasta (%35,9) sürekli renal replasman tedavisi hastaya uygulanmışken 93 hastaya (%64,1) aralıklı hemodiyaliz uygulanmıştır. Sürekli renal replasman tedavisi uygulanan hastalarda mekanik ventilasyon ve inotrop desteği daha sık kullanılmıştır (P=0,03). Toplamda, hastane içi mortalite oranı %73,1 iken taburculukta diyaliz bağımlı kronik böbrek hastalığı oranı %6,2 idi. mortalite oranı sürekli renal replasman tedavisi uygulanan hastalarda anlamlı olarak daha yüksekti (%84,6’ya karşılık %66,7, P=0,019).Sonuç: Çalışmamızın bulguları yoğun bakım hastalarında diyaliz gerektiren akut böbrek hasarının en önemli nedeninin sepsis olduğunu göstermektedir. Diyaliz gerektiren akut böbrek hasarı yaşlı hastalarda daha fazla görülmüştür ve kısa dönemli mortalite riskinde artış ile ilişkilidir., Aim: Dialysis-requiring acute kidney injury (D-AKI) in intensive care unit (ICU) continues to be associated with adverse outcomes of high mortality and dialysis-dependent chronic kidney disease (CKD). This retrospective study aimed to identify clinical characteristics of dialysis-requiring AKI and renal replacement therapy (RRT) which replaces the normal blood-filtering function of the kidneys in current ICU practice.Methods: This retrospective cohort study was conducted in a 20-bed, third level ICU of a University Hospital between 2011 and 2017. In total, 145 D-AKI patients who underwent RRT were identified. Hospital records of patients with D-AKI were retrospectively analyzed for demographics, medical history, clinical characteristics, details of RRT modality, and short-term outcome.Results: Of the 1689 patients investigated, 145 had D-AKI. The median age of the patients included in the study was 73 years. Septic etiology was the most common suspected cause for D-AKI development. Fifty-two patients (35.9%) underwent continuous RRT (CRRT) while intermittent hemodialysis was used in 93 patients (64.1%). Mechanical ventilation and inotropic support were more commonly used in CRRT patients than IHD patients (P=0.03). In total, in-hospital mortality rate was 73.1% while rate of dialysis-dependent CKD on discharge was 6.2%. Mortality rate was significantly higher in CRRT (84.6%) patients than in IHD patients (66.7%, P=0.019).Conclusion: Our study results reveal that sepsis appears to be the most important cause of D-AKI in intensive care patients. D-AKI was observed more frequently in elderly patients and associated with an increased risk of short-term mortality.

Hypothermia is described as a decrease in body temperature below 35 °C. Although the body reacts neuroendocrinally, behaviourally, and cardiovascularly against sudden changes in temperature, uncontrolled hypothermia can lead to severe complications such as rhabdomyolysis, acute renal failure, coma, coagulopathy, malignant cardiac arrhythmia, and cardiac collapse. Herein, we aimed to emphasize hypothermia, its serious complications such as rhabdomyolysis and related acute kidney injury in a 60-year-old male patient exposed to environmental cold., Hipotermi vücut iç sıcaklığının 35 °C’nin altına düşmesi olarak tanımlanmaktadır. Çevredeki ani ısı değişimlerine karşı vücut nöroendokrinal, davranışsal ve kardiovasküler olarak tepki göstermekle birlikte kontrol altına alınamayan hipotermi rabdomiyoliz, akut böbrek yetmezliği, koma, koagülopati, malign kardiyak aritmi, kardiyak kollaps vb. ciddi komplikasyonlara neden olabilmektedir. Bu olgu sunumu ile soğuğa maruz kalan altmış yaşındaki erkek hastada gelişen hipotermi ve hipoterminin potansiyel komplikasyonlarına vurgu yapılmak istenmiştir.

Purpose: Delaying the cord clamping for at least 30 seconds in infants who did not require cardiopulmonary resuscitation after birth has been recommended in the revised guidelines of American Academy of Pediatrics in 2015.We aimed to evaluate the effect of delayed cord clamping on hematological and biochemical parameters, need for hospitalization, oxygen, mechanical ventilation, phototherapy, and on sepsis, hyperbilirubinemia rate in late preterm and term infants.Material and Methods: This prospective study included 86 infants with a gestational age of 34 to 41 weeks. Infants were randomly included in one of two groups. While cords of 43 infants were clamped immediately after birth, cords of the other 43 infants were clamped after one minute. Hematological and biochemical values were evaluated both in cord blood and venous blood samples on 7th day of life. Results: Hemoglobin and hematocrit values were similar in two groups both in cord blood and on 7th day of life. Delayed cord clamping resulted in statistically significant decrease in the leukocyte and platelet coun and creatinine levels in the cord blood. Mechanical ventilation requirement was significantly lower in the delayed cord clamping group. Hospitalization rate, sepsis rate and hyperbilirubinemia rate were similar in both groups.Conclusion: Delayed cord clamping caused lower leucocyte, platelet counts and lower creatinine levels in cord blood. There seems a beneficial effect on respiratory status in late preterm and term infants., Amaç: Amerikan Pediatri Akademisi tarafından 2015 protokollerinde doğumdan sonra canlandırma ihtiyacı olmayan bebeklerde kord klemplenmesinin en az 30 dk geciktirilmesi önerilmiştir. Bu çalışmada term ve geç preterm bebeklerde geciktirilmiş kord klemplemenin, hematolojik ve biyokimyasal parametreler, hastaneye yatış, oksijen, mekanik ventilasyon, fototerapi ihtiyacına ve sepsis, hiperbilirubinemi hızına etkisini değerlendirmeyi amaçladık. Yöntem: Prospektif çalışmamıza 34-41 gebelik haftasındaki 86 bebek dahil edildi. Bebekler randomize olarak iki gruba ayrıldı. 43 bebeğin göbek kordonu doğumdan hemen sonra klemplenirken diğer 43 bebeğin kordonu doğumdan 1 dakika sonra klemplendi. Hematolojik ve biyokimyasal parametreler hem kord kanında hem de postnatal 7. günde alınan venöz örneklerde değerlendirildi.Bulgular: Hemoglobin ve hematokrit değerleri hem kord kanında hem de postanal 7. günde her iki grupta da benzerdi. Geciktirilmiş kord klemplenen grupta kord kanında lökosit ve tombosit değerleri istatistiksel olarak anlamlı düşüktü. Geciktirilmiş kord klemplenen grupta kord kanında kreatinin düzeyi anlamlı olarak düşük saptandı. Mekanik ventilasyon ihtiyacı kordu geç klemplenen grupta daha azdı. Hastaneye yatış, sepsis ve hiperbilirubinemi hızı her iki grupta da benzerdi.Sonuç: Geciktirilmiş kord klemplemesinin term ve geç preterm bebeklerde lökosit, trombosit ve kreatinin düzeylerinde düşüklüğe neden olduğu, solunum üzerine olumlu etkileri olduğu düşünüldü.

Amaç: Levetirasetam (LEV), yenidoğan döneminde nöbetleri tedavi etmek için giderek daha fazla kullanılmaktadır. Nöbet geçiren ileri derece preterm bebeklerde LEV kullanımı ile ilgili veriler yetersizdir ve sadece birkaç çalışma ile sınırlıdır. Bu çalışma, ileri derece preterm bebeklerde nöbetlerin tedavisinde LEV'in etkinliğini ve güvenilirliğini değerlendirmeyi amaçlamıştır.Yöntemler: Bu retrospektif kohort çalışma, Eylül 2017-Şubat 2019 tarihleri arasında ≤28. haftalık gebelik haftasında doğan ve yenidoğan nöbeti nedeniyle ilk doz intravenöz levetirasetamı postnatal 44. haftaya kadar alan ileri derece preterm yenidoğanlarda yapılmıştır. LEV’in yükleme ve idame dozu, daha önce kullanılan antiepileptik ilaçları, tedaviye yanıtı ve LEV'in yan etkileri kaydedildi.Bulgular: Levetirasetam alan 20 ileri derece preterm yenidoğan (9 erkek ve 11 kadın) değerlendirildi. Gestasyonel yaşları 23 ila 28 hafta arasında değişiyordu ve ortalama 26.5 hafta idi. Doğum ağırlıkları 520-1210 gr arasında değişiyordu 15 bebek (%75) aşırı düşük doğum ağırlıklıydı. Nöbetlerin tedavisi için başlangıçta birinci basamak tedavi olarak 12 hastaya (%60) levetirasetam başlandı ve sekiz hastaya (%40) ikinci veya üçüncü basamak antiepileptik ilaç olarak levetirasetam verildi. Tüm hastalarda LEV ile nöbet kontrolünün etkinlik oranı %60 (12/20) idi. Nöbet kontrolü sağlandığında ortalama LEV dozu 40 mg/kg olarak bulundu. LEV tedavisine bağlı herhangi bir yan etki gözlenmedi.Sonuç: Bu çalışma, LEV'in ileri derece preterm bebeklerde nöbet yönetimi için etkili ve güvenli olabileceğini göstermektedir. İleri derecede preterm bebeklerde LEV birinci basamak antiepileptik ilaç olarak verildiğinde nöbet kontrolü daha iyi sağlanmıştır., Aim: Levetiracetam (LEV) is increasingly being used to treat seizures in the neonatal period. Data about using LEV in extremely preterm infants with seizures is insufficient and limited with only a handful studies. This study aimed to evaluate the efficacy and safety of LEV in the treatment of seizures in extremely preterm infants.Methods: This retrospective cohort study was conducted on extremely premature newborns, those who were born ≤28 weeks of gestational age, and took their first intravenous dose of levetiracetam due to neonatal seizure before their 44th gestational week between September 2017-February 2019. Loading and maintenance dosage of LEV, previously used antiepileptic medications, response to treatment and side effects of LEV were recorded.Results: Twenty extremely preterm neonates (9 males and 11 females) who received LEV were evaluated. Gestational ages ranged from 23 to 28 weeks, with a median of 26.5 weeks. Birth weights ranged from 520-1210 gr and 15 infants (75%) had extremely low birth weights. For the treatment of seizures, 12 patients (60 %) were initially started on levetiracetam as first-line therapy and eight patients (40%) were administered levetiracetam as a second or third-line antiepileptic drug. The efficiency of seizure control with LEV was 60 % (12/20) in all patients. The median LEV dose at the time seizure control was achieved was 40 mg/kg. No side effects were observed due to LEV treatment. Conclusion: This study shows that LEV can be efficient and safe for seizure management in extremely preterm infants. Seizure control was better achieved when LEV was given as the first-line antiepileptic medication in extremely preterm infants.

Objective: To evaluate the outcomes of pregnancies with maternal heart disease. Material and Method: the results of 115 patients in our clinic between 2013 and 2018 were retrospectively analyzed. the type of heart disease and functional classification of the New York Heart Association were taken into consideration when evaluating the cases. Results: According to the New York Heart Association classification, the distribution of patients was 67.1% for stage I, 18.2% for stage II, and 14.7% for stage III–IV. There was no maternal or perinatal mortality. the incidence of rheumatic and congenital heart diseases was 51.3% and 27.8%, respectively. Maternal morbidity was observed in 18 cases (15.6%). Mean gestational age and birth weight were significantly higher in the stage I–II functional capacity group (p0.05). Conclusion: It is possible to obtain satisfactory results for both mother and fetus in the majority of pregnant women with heart disease when managed with a multidisciplinary approach. Amaç: Maternal kalp hastalığı bulunan gebeliklerin sonuçlarını değerlendirmek. Gereç ve Yöntem: 2013-2018 yılları arasında bir kliniğimizdeki 115 maternal kalp hastalığı olan olgunun sonuçları retrospektif olarak incelenmiştir. Olgular değerlendirilirken kalp hastalıklarının türü ve New York Kalp Derneği’nin fonksiyonel sınıflaması göz önünde bulundurulmuştur. Bulgular: New York Kalp Derneği sınıflamasına göre hastaların dağılımı evre I için %67,1, evre II için %18,2, evre III–IV için ise %14,7 idi. Maternal ya da perinatal mortalite saptanmadı. Romatizmal ve konjenital kalp hastalıklarının görülme oranı sırasıyla %51,3 ve %27,8 olarak bulundu. Maternal morbidite 18 olguda (%15,6) gözlendi. Ortalama doğum haftası ve doğum kilosu evre I–II fonksiyonel kapasiteli grupta belirgin yüksekti (p0,05). Sonuç: Multidisipliner bir yaklaşımla yönetildiğinde kalp hastalığı bulunan gebelerin çoğunluğunda hem anne hem fetüs için memnun edici sonuçların alınması mümkündür.

Pulmonary embolism (PE) is a life threatening emergency condition. PE is considered in suspected patients referring due to syncope or shock. Trombolytic treatment may be started for the patients with higher risk for PE according to transthoracic echocardiography (TTE) results. An eighty-year old female patient was taken to the emergency service at an unconscious state by her relatives. No pulse was detected in the first assessment. Cardiopulmonary resuscitation (CPR) was started. Return of spontaneous circulation (ROSC) was achieved at 15th minute of the CPR. TTE revealed dilation in the right ventricle and lower pressure in the left ventricle. There as not any risk factor for pulmonary embolism in preliminary diagnosis. The unstable patient was referred to CT angiography with emergency medicine physician. An image consistent with embolism in both branches of the pulmonary artery was detected in CT angiography and trombolytic treament was started. The patient was admitted to intensive care unit of the emergency service. Thrombolytic treatment may be implemented for high-risk patients for PE and in the patients who achieved return of spontaneous circulation after cardiac arrest. Furthermore, such interventions were detected to be life saving.

The most important goal of cardio-pulmonary resuscitation is to provide adequate blood flow to brain and heart by return of spontaneous circulation and this can be performed by chest compressions in cardio-pulmonary resuscitation. The most important fact for providing the best circulation is immediate, fast, continuous and high quality chest compression in 2015 American Heart Association (AHA) guideline. Therefore various mechanical chest compression devices are developed recently for more efficient chest compressions and entered the clinical usage. These devices may be considered for use in situations such as prolonged CPR, low number of rescuers, hypothermic cardiac arrest, ambulances in motion, extracorporeal CPR, during angiography which makes it difficult to perform high quality CPR. Apart from these conditions, mechanical chest compression devices should not be preferred to manual chest compression in in-hospital cardiac arrest cases.

Introduction:Low back pain is a global health problem that causes impediments in people's lives. The aim of this study was to evaluate the prevalence of low back pain of emergency department workers and to evaluate the risk factors with Oswestry Low Back Pain scale as the lumbar region of emergency department workers are vocationally subjected to straining movements due to heavy lifting and sudden movements.Method:The population of the study consists of the employees working in the emergency department within the specified date range. Although there were a total of 150 people in the double center, a total of 126 people agreed to participate because some of them were on leave and some did not want to participate in the study. The sample consisted of 27 doctors, 76 nurses, 12 medical secretaries, 11 cleaning personnel and security personnel. The Oswestry Low Back Pain scale was developed to assess functional impairment. Mann Whitney-U test and Kruskal Wallis –H test were used in statistical evaluations depending on the status of being a numerical independent group, since the correlated variables were categorical (nominal or ordinal) and binary or with more variables.Results:46.8% (n = 59) of the participants were female and 53.2% (n = 67) were male. When the participants were evaluated according to age groups, 3.2% (n = 4) were between 18-21 years, 49.2% (n = 62) between 22-27 years, 24.6% (n = 31) between 28-33 years, 17.5% (n = 22) ) 34-39 years old, 5.6% (n = 7) were over 40 years old. According to the sample size of our study, the annual prevalence of low back pain was 55.6% and the prevalence of lumbar hernia was 15.8% in the emergency service personnel. When the groups were evaluated in terms of the diagnosis of lumbar hernia, the OSA of those diagnosed with hernia was 17.52 ± 6.93 and those without lumbar hernia diagnosis was 8.4 ± 6.8. A statistically significant difference was found between the groups. A statistically significant difference was found in the ostwestry scale score between genders. This difference among the occupational groups was also found to be different statistically.Conclusion:The prevalence of low back pain in the society among the occupational groups, especially in the health sector, is high. In dynamic work environments such as the emergency department, solutions should be developed to reduce the determined risk factors in order to prevent low back pain symptoms after sudden and straining movement.

We sought to investigate the prevalence of skin tumors in Muğla, which has a Mediterranean climate and a high population of elderly people. This was a cross-sectional study conducted on patients, 65 years old and older, who consulted at our dermatology outpatient clinics between January 2014 and January 2015. Diagnoses of the patients were obtained and retrospectively evaluated from the electronic medical records of the hospital. Of 2297 geriatric patients, 50.8% were females and 49.2% were males. Of these patients, 12% had actinic keratosis, 5.4% had seborrheic keratosis, 2.1% had basal cell carcinoma, 0.8% had squamous cell carcinoma, and 0.1% had malignant melanoma. In patients

Diabetic retinopathy (DR) is a complication of diabetes mellitus (DM) that may causes blindness. The vitreous is an extracellular matrix and it may have changes through liquefaction and syneresis in patients with DM, even in those without apparent DR. Diffusion-weighted imaging (DWI) is a new technique provide tissue contrast relying on difference with the diffusion of water molecules among tissues, which can be measured by the apparent diffusion coefficient (ADC) value. We aimed to investigate the vitreous of patients in different stages of DR using diffusion-weighted imaging technique. This prospective study included a group of 100 patients with DR and 100 members of an age- and gender-matched control group. All groups were tested using a head coil in conduction with a Achieva 1.5T magnetic resonans imaging (MRI) system (Philips Medical Systems, Best, The Netherlands). The mean ADC values were calculated and used for statistical comparisons. Mean duration of diabetes was 12.22±10.13 years in patients. Compared to controls, both eyes of the DR group had statistically and significantly lower values of ADC (p=0.025 and p=0.002, respectively). No significant correlations were found among the ADC values and central macular thickness, disease duration and stage of DR (all p>0.05) in patients. Mean ADC values revealed no significant differences among the subgroups of patients at different stages of DR (all p>0.05). Decreased ADCs in the vitreous of diabetes patients seem to be associated with the presence of diabetic retinopathy. [Med-Science 2018; 7(1.000): 106-109]

Aim: Traumatic brain injury (TBI) is one of the common emergencies with a high mortality rate. It is difficult to determine the mortality and prognosis of TBI in the intensive care unit (ICU). The aim of this study is to assess the prognostic relationship of optic nerve sheath diameters (ONSD) as seen on computerized tomography (CT) images as well as serum procalcitonin (PCT) levels to mortality and Glasgow Outcome Scale (GOS) scores of patients with traumatic brain injury in the ICU.Methods: Data from 78 traumatic brain injury patients who were admitted to an ICU, underwent brain CT and had serum PCT levels measured, were investigated retrospectively. Patients’ data were gathered from ICU medical records. The ONSD was measured at 3 mm behind the globe. Results: The mean age of the patients was 57.11 (17.07) years. 57.7% of the patients were males, and 42.3% were females. The cut-off ONSD and serum PCT values were evaluated to determine mortality and prognosis (Cut-off values: right ONSD: 5.44, left ONSD: 5.37, PCT: 3.95 for mortality; right ONSD: 5.26, left ONSD: 5.28, PCT: 2.29 for GOS, respectively).Conclusion: ONSD measurements and serum PCT levels are associated with mortality and prognosis in traumatic brain injury patients., Amaç: Travmatik beyin hasarı (TBH) yüksek mortalite oranı ile sonuçlanan sık karşılaşılan acillerden biridir. Yoğun bakım ünitesinde (YBÜ) TBH için mortalite ve prognozu belirlemek zorudur. Bu çalışmanın amacı, YBÜ’deki travmatik beyin hasarı olguların mortalite ve Glasgow outcome skalası ile bilgisayarlı tomografi (BT) görüntülerinden elde edilen optik sinir kılıf çapı ve serum prokalsitonin seviyeleri arasındaki ilişkiyi göstermek ve optik sinir kılıf çapıyla prokalsitonin seviyesinin prognostik değerini ölçmektir. Yöntemler: Beyin BT görüntülemesi yapılmış ve serum prokalsitonin düzeyi çalışılmış 78 travmatik beyin hasarı hastasının verileri retrospektif olarak incelendi. Hasta verileri yoğun bakım tıbbi kayıtlarından elde edildi. Optik sinir kılıf çapı göz güresinin 3 mm arkasından ölçüldü. Bulgular: Hastaların yaş ortalaması 57,11 (17,07) iken %57,7’si erkek, %42,3’ü kadındı. Optik sinir kılıf çapı ve serum prokalsitonin cut-off değerleri, mortalite ve prognozu belirlemek için hesaplandı. Mortalite için cut-off değerleri sırasıyla: Sağ ONSD: 5,44, sol ONSD: 5,37, PCT: 3,95, GOS için sağ ONSD: 5,26, sol ONSD: 5,28, PCT: 2,29’du. Sonuç: Optik sinir kılıf çapı ölçümü ve prokalsitonin seviyeleri travmatik beyin hasarlı hastalarda mortalite ve prognoz ile ilişkilidir.

To test the null hypothesis that bony pelvis dimensions are different in women with and without polycystic ovarian syndrome (PCOS). In this case-control study all subjects underwent hysterosalphingography examination. The interspinous, intertuberous diameters and subpubic angle were measured from the images independently by author blinded to the clinical and laboratory data of the patients. Women with PCOS had shorter interspinous diameter. There was no significant differences in the length of intertuberous diameters and subpubic angles between the two groups. Significant difference in interspinous diameter was identified when comparing reproductive-aged women with PCO and their similar aged controls. [Med-Science 2018; 7(3.000): 681-3]

Purpose: The aim of this study was to investigate the relationship between serum dynamic thiol-disulfide homeostasis (TDH) and sepsis, in adult patients.Materials and Methods: In this observational, prospective, case-control study patients (n=44) diagnosed with sepsis compared with ages and gender-matched healthy controls (n=44). Patients were divided into two subgroups (survivors and non-survivors) dependent variable being remaining alive on the 28th day after ICU admission at the follow-up period. TDH parameters measured using a novel automatic and spectrophotometric method and compared statistically.Results: In patients with sepsis, native thiol, total thiol, and disulfide levels were lower than the control group, and this difference was statistically significant. TDH parameters between surviving and non-surviving patients were similar at the sepsis diagnosis. However, significant differences found in native and total thiol levels at follow-up via repeated measurement analyses on days 3 and 7 in surviving and non-surviving sub-groups. Conclusion: This study showed that impairment in dynamic TDH in adults with sepsis may be related to negative outcomes., Amaç: Bu gözlemsel, prospektif, vaka kontrol çalışmasında erişkin hastalarda serum dinamik Tiyol-Disülfir Homeostazisi (TDH) ile sepsis arasındaki ilişkiyi araştırmayı amaçladık.Gereç ve Yöntem: Sepsis tanısı ile alan 44 hasta, yaş ve cinsiyet uyumlu 44 sağlıklı kontrol ile karşılaştırıldı. Hastalar yoğun bakım ünitesi yatışından sonraki 28. günde sağ-kalan ve hayatını kaybedenler olarak 2 gruba ayrıldı. TDH parametreleri yeni, otomatik ve spektrofotometrik bir yöntem kullanılarak ölçüldü ve sonuçlar istatistiksel olarak karşılaştırıldı.Bulgular: Sepsisli hastalarda, nativ tiyol, total tiyol ve disülfit seviyeleri kontrol grubuna göre daha düşük olarak bulundu ve bu fark istatistiksel olarak anlamlı idi. Başlangıç TDH parametreleri sağ-kalan ve hayatını kaybeden hastalar arasındaki benzer bulundu. Ancak sağ kalan ve ex olan hastaların 3 ve 7. günde tekrarlanan TDH ölçümleri (nativ ve toplam tiyol seviyeleri) arasında anlamlı farklar bulundu.Sonuç: Bu çalışma, erişkin sepsis hastalarında dinamik TDH'deki bozulmanın negatif sonuçlara ilişkili olabileceğini göstermiştir.

Pediatric head trauma is one of the most importantpublic health issues worldwide and is one of the most common causes ofmorbidity and mortality in this age group. In infants, trauma of the sameseverity with adults bring different outcomes as the body structure isdifferent compared to adults. Imaging methods are frequently used in infantspresenting with trauma, since children in the 0-2 age group cannot expressthemselves, their neurological examination is limited and families of infantscannot provide clear information about trauma. The best imaging method for trauma is cranial computed tomography (CCT).In this study, patients aged 0-2 years who applied to an emergency departmentof a training and research hospital in Istanbul between January 1, 2018 andJanuary 31, 2018 were examined retrospectively. The aim of this study was todetermine a clinical pathway by evaluating cranial computed tomography imagingsof 0-2 year-old pediatric patients brought to the emergency department for headtrauma. In our study, 523 patients aged 0-2 years were admitted for traumabetween the specified time period and 166 of these patients underwent CCT. Ofthe patients who underwent CCT, 9% (n=15) were found to have pathology due totrauma. Ten of these patients underwent follow-up CCT. One of 15 patients was found to have bonefracture. The other 14 patients were suspected of contusion. Of the patientswho underwent CCT, 3.1% (n=5) were admitted to the ward for follow-up.When the patients were evaluated in terms of clinicalcourse, hospitalization or discharge in our study, they were found to correlatewith pathologies detected on CCT.Due to the intensity of the patients in the emergencydepartment, sufficient time cannot be allocated for the examination andinforming of patients. It was observed that Cranial CT request frequencyincreased especially between 16: 00-00: 00 hours when emergency departmentintensity increased.In infant trauma patients, imaging studies should bedetermined considering the severity and mechanism of trauma.

Objectives: This study was intended to discuss the process of brain death diagnosis of patients undergoing extracorporeal membrane oxygenation (ECMO) and our approach regarding the existing literature. Methods: Demographics data (age, gender, admission diagnosis) were noted. ECMO type applied (veno-venous or veno-arterial), time of diagnosing brain death (the time from admission time till diagnosis), being a donor or not, apnea testing application, supplementary tests applied at diagnosis stage (cerebral angiography, computerized tomography angiography, electroencephalography, transcranial doppler ultrasonography), and time of cardiac death (the time elapsing from the moment of brain death diagnosis till cardiac arrest) were noted. Results: Forty-two patients data were exaimed and ECMO was applied to 8 patients, 4 of whom are female and the others are male. The average age of the patients is 61.8 ± 9.8 years. The average time elapsing from the hospitalization till brain death diagnosis was 2.5 ± 0.5 days. Apart from that, only 2 (25%) of the patients were donors.Conclusions: The use of modified apnea testing on patients undergoing ECMO could be proliferated if such tests are standardized and reliable guidelines are set. For this reason, we think that cerebral angiography should be kept in mind in addition to apnea test especially on ECMO-treated patients.

Etiologicaldiagnosis of pleural effusion is sometimes easy and sometimes very difficultchallenge. In most of patients with pleural effusion, the symptoms, signs andlaboratory data are not pathognomonic for etiologic diagnosis. In a patient with an undiagnosed pleuraleffusion, the first question to answer is whether the fluid is a transudate oran exudate. This is usually determined by means of Light's criteria. Inpatients under diuretic treatment, Light's criteria misclassify transudates asexudates, but the pleural fluid NT-pro-BNP levels usually is above 1500 pg/mLin pleural effusions associated with heart failure.

INTRODUCTIONInfrared rays(IR) have been used in many areas in recent years and nowadays, many devices have been developed with the aim of heating in open,closed areas working with infrared technology.IR can cause retinopathy.They have the risk of developing periocular skin burns, corneal epitheliopathy,retinopathy.In this study, we wanted to talk about eight cases who were exposure with infrared light in a chemical manufacturing factory where Infrared light was used for drying and all of 8 patients had burning, stinging, watering,redness in the eyes.

Uvula hematoma is morecommonly seen as a complication of thrombolytics and streptokinase use or aftertrauma. Although spontaneous uvula hematoma is rare in the literature, we aimto present a rare spontaneous uvula hematoma in our case. A 26-year-old womanwas admitted to the emergency service with a feeling of sticking in her throatand difficulty in swallowing. There were no features in the patient's medicalhistory. In her physical examination, the uvula was ecchymotic and edematous.She stated that she does not use any antiplatelet and anticoagulant agents.Other system examinations were normal. In some studies, uvula hematoma have been reported afterendotracheal intubation and use ofantiplatellet. However, uvula hematoma was spontaneously formed in the patientwho applied to us. As with all emergency cases, hemodynamic stability andairway patency should be maintained in the first intervention in such airwayhematomas. After maintaining the airway, anticoagulation therapy or hematoma drainage,if necessary, constitute the second step of hematoma treatment. The main causeof Uvula hematomas is trauma and anticoagulant therapy. In the management ofthese patients, priority is to maintain airway clarity. The upper aerodigestivesystem should be checked for bleeding after trauma, endoscopy and intubation,especially in patients with anticoagulant therapy and in patients with systemicbleeding disease.

Objective:The aim of the study was to determine the emotional state, experience ofpatients in the intensive care unit and the factors affectingthem.Methods:This descriptive study and cross-sectional study was performed the educationand teaching hospital in the western region of Turkey. 120 patients with femur fracture hospitalized at surgicalintensive care unit were included in the study. The ethical approval was obtained before the study.The data were collected using a personal information form, the Intensive CareExperience Scale (ICES), and the Hospital Anxiety Depression Scale (HADS). Descriptivestatistics, Mann Whitney U test, Kruskall Wallis test and regression analysis were used for data analysis.Results:The mean total scores of the patients were 51,61±6,43 for ICES, 5,26±3,90 forHADS anxiety, and 4,21±2,79 for HADS depression. Recollection of intensivecare, pain, and intensive care temperature had an effect on the intensive careexperience of the patients (p, Amaç: Buçalışma yoğun bakım ünitesinde yatan hastaların emosyonel durumları,deneyimleri ve bunları etkileyen faktörleribelirlemek amacı ile yapıldı.Gereçve Yöntem: Tanımlayıcı ve kesitsel tipteki bu araştırmaTürkiye’nin Batı Bölgesindeki bir Eğitim ve Araştırma Hastanesi'nde yapıldı.Çalışmaya femur fraktürü nedeni ile cerrahi yoğun bakım ünitesinde yatan 120hasta dahil edildi. Çalışma öncesinde etik kurul onayı alındı. Araştırmaverileri, kişisel bilgi formu, Yoğun Bakım Deneyim Ölçeği (YBDÖ) ve Hastane AnksiyeteDepresyon (HAD) ölçeği kullanılarak toplandı. Verilerin analizinde tanımlayıcıistatistikler, Mann Whitney U testi, Kruskal Wallis testi ve regresyon analizikullanıldı.Bulgular:Hastaların ölçeklerden aldıkları toplam puan ortalamaları sırası ile YBDÖ: 51,61±6,43,HAD anksiyete: 5,26±3,90, HAD depresyon: 4,21±2,79'dur. Hastaların yoğun bakım deneyimlerine yoğun bakımıhatırlama durumu, ağrı ve yoğun bakım ısısının etkili olduğu saptandı (p

Shingles is one of the two different clinical presentations of infection ofVZV which is a DNA virus. Humans are a known reservoir for the Varicella zostervirus (VZV). It is very contagious. The virus that remains latent afterinfection in childhood and can be reactive due to various reasons (immunesystem suppression, old age, stress factors, etc.). It involves various dermatomes after reactivation. Varicella-zoster appears mostly on thoracic,cervical, and ophthalmic dermatomes. Rarely, it is located in the upper andlower extremity dermatomes. In thisstudy; 7 patients with shingles on the foot and sole were examined. It wasaimed to emphasize that varicella zoster (zona) may be the cause of foot painin patients presenting to the emergency department with complaints such aspain, burning and inability to step on standing, and to review the age, gender,underlying factors of the zona cases which are not previously mentioned in theliterature.

INTRODUCTION: The aim of this study was to determine the demographic characteristics of the patients followed in the Emergency Intensive Care Unit (EICU) of Kanuni Sultan Süleyman Training and Research Hospital. METHODS: Demographic characteristics such as age, gender and non-invasive mechanical ventilation / invasive mechanical ventilation (NIMV / IMV) requirements, mortality and morbidity rates between 24 November 2018-1March 2019 were examined retrospectively.EICU; is a 5-bed service and managed by an emergency doctor and 2 intensive care nurses for 24 hours.EICU works physically as a level 1 but functionally level 3. It is the first intensive care unit in Istanbul which is in the emergency department and managed by emergency specialists.RESULTS: A total of 68 patients were included in the study. Of the patients 58.8% (n = 40) were male, 41.2% (n=28) were female and 17.6% (n=12) were foreign nationals.According to the diagnosis of EICU admission, 25.0% (n=17) pneumonia, 17.6% (n=12) cerebrovascular diseases (CVH), 13.2% (n=9) acute renal failure (ARF), 11.8% (n=8) trauma 10.3% (n=7) multiple organ failure syndrome,7.4% (n=5) malignancy, 5.9% (n=4) gastrointestinal bleeding, while 2.9% (n=2) were listed as other reasons.41.2% (n=28) of the patients were followed as intubated,58.8% (n=40) were followed as extubated.The mean day of stay of patients in intensive care unit was 5.9 days.DISCUSSION AND CONCLUSION: This three-month intensive care experience showed that the rate of complications and mortality was similar to the literature and the quality of patient management was similar to the third level intensive care services.EICU’s can be considered as a solution where intensive care is needed.

The Osborn wave which is also known asthe J wave in electrocardiogram (ECG) is most commonly detected in the caseswith hypothermia. Furthermore, this wave may develop as secondary to manyconditions such as hypercalcemia, hypoglycemia, brain damage, ischemic heartdisease. The Osborn wave disappears when the underlying cause is recovered. Asis known, alcohol is a substance made of ethyl alcohol which may cause severecardiac problems such as cardiomyopathy, cardiac arrhythmia and cardiac arrestIn the present case report, we wanted to address the association of a typicalOsborn wave with high blood level of alcohol by presenting two cases whomOsborn wave was detected after cardiac arrest and hypothermia developedsecondary to high alcohol level in the blood; and discuss the association betweenOsborn wave and high blood levels of alcohol.