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Aluminum phosphide (AlP) is a commonly used cheap rodenticide, insecticide, and fumigant. Most intoxications in the literature are suicidal ingestions, however, AlP may cause incidental inhalational toxicities as well. After ingestion or inhalation, nausea, vomiting, dyspnea and abdominal pain develops within minutes. Hallmark of toxicity is refractory hypotension, cardiac failure and severe metabolic acidosis developing within a matter of hours are the major cause of mortality. In Turkey, AlP tablets are widely accessible and are sold without any restrictions. However, there are few local case reports in the literature. Additionally, incidental AlP intoxications are rarely reported. Herein, we present a 25-year-old male patient incidentally poisoned with AlP. He was found unconscious in a grain storage unit protected by aluminum phosphide tablets. He had hypotension and tachycardia. Arterial blood gas analysis did not reveal metabolic acidosis. He was quickly intubated and admitted to Intensive Care Unit (ICU). Supportive care crystalloid solution, n-acetyl cysteine and norepinephrine infusion was administered. After 36 hours, he was extubated and discharged without any complications. There is no specific antidote or treatment for AlP toxicity. Literature is controversial regarding treatment approach. Inhalational toxicity may occur under extreme conditions, as presented in this case report. Preventive strategies should be considered to reduce incidents. Clinicians should also be aware that AlP is a widely available and highly toxic compound that has no specific antidote and toxicity needs to be urgently treated with best supportive care.

Objective: The aim of the study was to evaluate the frequency, patient characteristics, complications and the prognosis related with our percutaneous dilatational tracheotomy (PDT) practice. Materials and Methods: Hospital electronic records and intensive care unit (ICU) data of the patients with PDT performed in our 33 bed anesthesiology ICUs were used between 2010 and 2014. Results: Percutaneous tracheotomy was performed in 442 patients who were taken to work in surgery for 29 and for 413 in the ICU. Average tracheotomy opening day was 9.96 (1-46) and overall complication frequency was found 7.0% (23 early and 8 late complication). The most frequent early complication was bleeding (2.9%). Among survivors; 61.6% were decannulated, 18.6% were discharged with home type ventilator, 13% were discharged with tracheotomy cannula at spontaneous ventilation and 6.5% patients were discharged with a small sized tracheotomy cannula for pulmonary aspiration. Conclusion: In this study, the expected results were obtained in terms of the timing of tracheotomy and the frequency of complications. End of life decisions in our country are often not implemented due to the refusal of patient relatives and legal uncertainty. The vast majority of our tracheotomized patients have inevitable mortality with intracranial pathologies. For this reason, we think that our study group had a higher ICU hospital stay and mortality, because it is necessary to apply tracheotomy due to prolongation of translargeal intubation period in patients.

Objective: To evaluate all obstetric patients admitted to intensive care unit (ICU). Materials and Methods: Ninety-four obstetric patients were evaluated for age, mortality, preexisting disorders, the reason for admission, interventions performed during ICU stay, and the source of admission. Results: The mean age was 29.1±5.5 years and the mean APACHE II score was 13.2±4.8. Most common reasons for intensive care admission were eclampsia (26%) and hemorrhage (20%). In 23 cases, there was at least one preexisting medical disorder and the most common disorder was valvular heart disease. The incidences of central venous catheterization, arterial cannulation, and hemodialysis were 39.4%, 79.8%, and 11.7%, respectively. Of the patients, 2 were admitted from the emergency room, 3 were from the ward, 55 were from operation room, and 34 patients were transferred from other hospitals. The mean length of stay in ICU was 4.7±7.1 days in patients transferred from another hospital, whereas it was 1.9±2.8 days in the patients admitted from other departments of our hospital (p

Objective Despite advances in immunosuppressive drugs, postoperative care, and surgical techniques, bacterial infections remain the most important cause of morbidity and mortality in liver transplant patients. The aim of this study is to evaluate the influence of culture results taken on the first day of admission to intensive care unit on mortality, graft rejection, mechanical ventilation duration, and length of intensive care unit stay. Our study has clinical importance because it is the first study evaluating the cultures obtained on the first day of intensive care unit stays in liver transplant patients. Methods Patients' demographic data, transplant type, rates of deceased and living donors, culture results, amount of blood and blood products used intraoperatively, previous hospital admission, mortality, incidence of graft rejection, mechanical ventilation duration, and length of intensive care unit stay were recorded. Results Mortality and graft rejection were 14.8% and 9%, respectively. The mortality was significantly higher in all 3 cultures and/or in only blood culture–positive patients. Graft rejection, mechanical ventilation duration, and length of intensive care unit stay were significantly higher in patients whose 3 cultures were all positive. Only body mass index had a significant effect on mortality, graft rejection, and positive culture results. Conclusions Liver transplant patients' first postoperative day culture results were correlated with mortality, graft rejection, mechanical ventilation duration, and length of intensive care unit stay.

OBJECTIVE: Solid organ transplantation is a rescue therapy, whereas face transplantation, as well as other composite tissue allotransplantations, offers treatment options to enhance the quality of life. Difficult airway, severe haemorrhage and prolonged operative length are among the frequently encountered complications of anaesthetic management in patients with a history of multiple reconstructive surgeries. METHODS: Five face allotransplants that were performed in our institute, arising from four full and one partial face transplantations, were reviewed. The pitfalls encountered before, during and following surgery were then summarised. RESULTS: Two of our patients (patients 3 and 4) underwent permanent tracheostomy preoperatively. Transplantation was initiated after surgical tracheostomy under local anaesthesia and under sedation in cases 2 and 5. Patient 1 was orally intubated without difficulty under general anaesthesia and was operated following tracheal cannulation via surgical tracheostomy. Thirteen units of red blood cells were transfused each for patients 2 and 4. Two other patients (patients 1 and 4) each received 5 units of red blood cells. Patient 5, who underwent mid-face transplantation lasting for 7.5 h, was not transfused. No major life-threatening complications were observed intraoperatively or following surgery. CONCLUSION: Face transplantation is a surgical procedure in which anaesthetic management may be problematic. The anaesthetist may encounter difficulties, such as difficult airway, severe bleeding, a prolonged operative time and postoperative complications. Side effects and complications may be reduced by strict follow-up and haemodynamic monitoring of patients.

WOS: 000447618800009, PubMed: 30322437, OBJECTIVES: We aimed to obtain information about the characteristics of the ICUs in our country via a point prevalence study. MATERIAL AND METHODS: This cross-sectional study was planned by the Respiratory Failure and Intensive Care Assembly of Turkish Thoracic Society. A questionnaire was prepared and invitations were sent from the association's communication channels to reach the whole country. Data were collected through all participating intensivists between the October 26, 2016 at 08:00 and October 27, 2016 at 08:00. RESULTS: Data were collected from the 67 centers. Overall, 76.1% of the ICUs were managed with a closed system. In total, 35.8% (n=24) of ICUs were levels of care (LOC) 2 and 64.2% (n=43) were LOC 3. The median total numbers of ICU beds, LOC 2, and LOC 3 beds were 12 (8-23), 14 (10-25), and 12 (8-20), respectively. The median number of ventilators was 12 (7-21) and that of ventilators with non-invasive ventilation mode was 11 (6-20). The median numbers of patients per physician during day and night were 3.9 (2.3-8) and 13 (9-23), respectively. The median number of patients per nurse was 2.5 (2-3.1); 88.1% of the nurses were certified by national certification corporation. CONCLUSION: In terms of the number of staff, there is a need for specialist physicians, especially during the night and nurses in our country. It was thought that the number of ICU-certified nurses was comparatively sufficient, yet the target was supposed to be 100% for this rate.

Background: An increased risk of cardiovascular complications has been defined in community-acquired pneumonia (CAP), but limited data is available for patients with severe CAP. Aims and objectives: The aim of the present study was to define the prevalence, characteristics, risk factors and impact on mortality of acute cardiovascular events (CVEs) in patients with severe CAP. Methods: This investigation was a retrospective cohort sudy of patients with severe CAP. CVEs were defined as cardiac arrhytmia, congestive heart failure and myocardial infarction. Those with and without events were compared across specific variables by logistic regression to ascertain factors that independently increase the risk. Results: Of 373 patients (mean age 74.5±11.1, 61.3 % male), 56 (15%) developed a cardiovascular event (43 arrhythmia, 11 congestive heart failure and 2 myocardial infarction). Patients who developed an acute cardiovascular event were older, had more severe disease, had more pleural effusion, more hypoalbuminemia and more acidosis. Also, beta-blocker, diuretic, haloperidol and vasopressor use were more significant in these patients. According to the logistic regression analysis, haloperidol use (OR 3.0), hypoalbuminemia (OR 2.6) and diuretic use (OR 2.3) were the most strongest predictors for acute cardiovascular events. Acute CVEs were significantly associated with in-hospital mortality (OR 2,187; 95%CI 1,036-4,615, p=0.046) but not associated with 1 or 3 months mortality. Conclusion: Our findings demonstrated that acute CVEs are not seldom in severe CAP and it is associated with poor prognosis in hospitalized patients.

Introduction: One day point prevalence study to evaluate patient profile in ICUs was planned by Turkish Thoracic Society Respiratory Failure and Intensive Care Group. Methods: The study was cross-sectional and data were obtained by a questionnaire in participating ICUs on October 26th 2016 for 24 hours. A questionnaire evaluating characteristics of patients in ICU was prepared. A total of 78 units declared to participate in the survey. Results: Ten centers were excluded from the study because they couldn’t participate on study day. A total of 922 patients were enrolled from 68 units. The mean age was 64.8 ± 17.9 (17-99), 58.6% were male. The mean APACHE II, QSOFA and GCS scores on the study day were 18.5 ± 8.8, 1.4 ±1.4 and 10.2 ± 4.3, respectively, and mean length of stay (LOS) was 20 ± 70 days. The patients were admited from emergency room(44%[n=407]), clinics(39%[n=359]) and other ICUs(17%[n=156]).38.5% of patients had Type 1 respiratory failure(RF),35.6% had Type 2 RF. Comorbidity was seen in 80.6% and malignancy rate was 18.8%. On the study day it was found that 52.1% of the patients underwent invasive mechanical ventilation(IMV),12.3% of the patients had non-invasive ventilation(NIV) 29.1% of them had oxygen therapy. Tracheostomy was performed in 19.7% of patients. 70% of the patients had enteral, 20.7% had parenteral nutrition. The discharge rate was 7% while mortality was 1.1% on that day. Discussion: Most of the patients in ICUs are respiratory failure cases admited from emergency department and clinics. Advanced age, presence of comorbidities and cancer are thought to prolong LOS in ICU. For effective use of ICU beds further regulations for patient admission criteria is necessary.

We describe the first rescue procedure in a case of total face allotransplantation. The recipient was a 54-year-old man with severe disfigurement of the entire face following an accidental gunshot injury 5 years previously. The large defect included the maxilla, mandible, and mid-face. Full face procurement was performed from a multiorgan cadaveric donor and was allotransplanted to the recipient. The post-transplant induction immunosuppressive regimen included ATG combined with tacrolimus, mycophenolate mofetil, and prednisone, while maintenance was provided by the last three of these. Although the early postoperative period was uneventful, squamous cell carcinoma developed in the upper and lower extremities in the fifth postoperative month, and post-transplant lymphoproliferative disorder (PTLD) occurred in the sixth month postoperatively. Malignancies were treated, involving both surgical and medical approaches. The patient developed opportunistic pulmonary and cerebellar aspergillosis. In order to reduce the adverse affects and metabolic and immunological load, the transplanted face was removed and replaced with a free flap. Although the early postoperative period was promising, with the transferred flap surviving totally and all vital signs and general status appearing to be improving, the patient was eventually lost due to complicated infectious and metabolic events. Although this case was unsuccessful, we suggest that the immunological and metabolic load should be reduced as soon as stable medical conditions are established in case of diagnosis of a situation involving a high rate of mortality, such as PTLD and untreatable opportunistic infections. This should include withdrawal of all immunosuppressive drugs and removal of all allotransplanted tissues.

To examine the use of prognostic factors such as age, Glasgow Coma Scale (GCS) score, pupil reactivity and computerized tomography (CT) findings for predicting the prognosis of severe traumatic brain injury (TBI) patients in Turkey.We retrospectively evaluated TBI patients who were accepted to Akdeniz University Intensive Care Unit between 1 January 2007 and 31 December 2009. Patient data were collected from the hospital information system. Marshall CT classification was performed and CT findings were noted. The Glasgow outcome scale (GOS) score of patients was calculated according to their 6-months follow up.A total of 101 patients with severe TBI were studied. The mean age of the patients was 34.7 ± 14.1 years. Of these, male patients (81.2%) were dominant and road accidents (83.2%) were the most common mechanism of TBI development. In addition, poor neurological outcome was detected in 58.4% of the patients and 29 patients (28.7%) died. The mechanism of injury (p = 0.34), gender (p = 0.64) or age (p = 0.34) did not lead to a difference in neurologic outcomes while the GCS score (p = 0.01), pupillary reactivity (p = 0.000), Marshall CT classification (p = 0.01) and the presence of traumatic subarachnoid haemorrhage (p = 0.04) affected the GOS scores.In our study, GCS score, CT findings and pupil reactivity were prominent as prognostic factors, but a relationship between age and prognosis was not observed.

This was a single-centre, prospective study to assess the frequency of neurological complications and their impact on prolonged hospitalization in 137 liver transplant patients presenting between September 1997 and June 2010. Neurological complications were seen in 22 (16%) patients during their postoperative stay in the intensive care unit. Complications included new-onset, recurrent headache (five patients), generalized seizures (four patients), dysarthria (two patients), delirium with agitation (three patients), persistent flapping tremor (two patients), alteration in level of consciousness (three patients), central pontine myelinolysis (one patient), myopathy (one patient) and visual hallucinations (one patient). Seizures were associated with immunosuppressive drug toxicity (tacrolimus). Myopathy presenting as quadriplegia was diagnosed by muscle biopsy. The patient with central pontine myelinolysis lived in a persistent vegetative state for 2 years and died of pneumonia. In conclusion, neurological complications are frequently encountered after liver transplantation, and are an important cause of severe morbidity and prolonged intensive care unit and hospital stay.

Objective.To describe the incidence of device-associated nosocomial infections in medical-surgical intensive care units (MS ICUs) in a university hospital in Turkey and compare it with National Nosocomial Infections Surveillance (NNIS) system rates.Design.Prospective surveillance study during a period of 27 months. Device utilization ratios and device-associated infection rates were calculated using US Centers for Disease Control and Prevention and NNIS definitions.Setting.Two separate MS ICUs at Akdeniz University Hospital, Antalya, Turkey.Patients.All patients were included who presented with no signs and symptoms of infection within the first 48 hours after admission.Results.Data on 1,985 patients with a total of 16,892 patient-days were analyzed. The mean overall infection rate per 100 patients was 29.1 infections, and the mean infection rate per 1,000 patient-days was 34.2 infections. The rate of ventilator-associated pneumonia was 20.76 infections per 1,000 ventilator-days, the rate of catheter-associated urinary tract infection was 13.63 infections per 1,000 urinary catheter–days, and the rate of catheter-associated bloodstream infection was 9.69 infections per 1,000 central line–days. The most frequently isolated pathogens were Pseudomonas species among patients with ventilator-associated pneumonias (35.8% of cases), Candida species among patients with catheter-associated urinary tract infections (37.1% of cases), and coagulase-negative staphylococci among patients with catheter-associated bloodstream infections (20.0% of cases).Conclusion.We found both higher device-associated infection rates and higher device utilization ratios in our MS ICUs than those reported by the NNIS system. To reduce the rate of infection, implementation of infection control practices and comprehensive education are required, and an appropriate nationwide nosocomial infection and control system is needed in Turkey.

Percutaneous tracheostomy is a widely used and accepted method for long-term mechanical ventilation and airway protection. Neurocritically ill patients sometimes require repeat tracheostomy, which is traditionally considered a relative contraindication for percutaneous procedure. The aim of this study was to determine the safety of repeat percutaneous tracheostomy in neurocritically ill patients with a history of previous tracheostomy.In the 16-bed academic neurointensive care unit, we prospectively enrolled patients who needed new tracheostomy placement for airway protection or prolonged mechanical ventilation and had previously undergone percutaneous tracheostomy placement. We collected data on indications, procedure, periprocedural complications, and outcome of repeated tracheostomy.Between January 2001 and October 2005, we enrolled 12 consecutive patients (mean age 35.4 +/- 7.0 years) who underwent repeat percutaneous tracheostomy. Head injury was the most common underlying diagnosis (seven patients, 58%). Tracheostomy tube placement was easy and successful in all patients, and none of the patients needed conversion to surgical tracheostomy. In three patients, ultrasound-guided needle aspiration was used before the procedure to confirm the position of the trachea. No patients died or experienced serious complication related to the procedure. Two patients (17%) had a minor periprocedural bleeding, which was controlled with local compression. Long-term outcome was poor, with only two patients alive and off the ventilator at hospital discharge, both with serious disability.Repeat percutaneous tracheostomy can be performed safely in neurocritically ill patients who have undergone previous tracheostomy.

Organophosphates are the most common group of chemicals in the southern part of Turkey. Although organophosphate poisoning (OPP) may occur due to skin exposure or inhalation, severe poisoning is usually the result of ingestion to attempt suicide. Despite the fact that there have been a lot of experimental studies using intravenous or percutaneous injection of organophosphates, reports of human poisoning due to percutaneous injection are rare. The systemic signs of OPP have not been described in these reported patients. We report 2 cases having systemic signs of OPP due to percutaneous injection. In our first case, we noticed a 17-day muscle weakness and a 12-day muscarinic syndrome, which required prolonged atropinization. In the second patient, atropine infusion had to be continued for 2 days. Both cases also had severe swelling of the affected limb and wound infection. In conclusion, in cases of percutaneous injection of organophosphates systemic toxicity may develop in addition to local findings such as necrosis and abscesses. Close observation for evidence of systemic involvement is required, and the patient should be carefully monitored for secondary abscess formation and any delayed impairment of neurologic function.

Maghsoudi, Behzad/0000-0002-1279-8799; Kritsotakis, Evangelos/0000-0002-9526-3852; Yalcin, Ata Nevzat/0000-0002-7243-7354; Mikaszewska-Sokolewicz, Malgorzata A/0000-0002-1148-7817; ALDEMIR KOCABAS, Bilge/0000-0002-6396-5243; Masjedi, Mohammad Reza/0000-0002-6871-382X; Masjedi, Mansoor/0000-0001-6175-9289; Gan, Chin Seng/0000-0002-6758-4798; Oncul, Oral/0000-0002-1681-1866; Sabetian, Golnar/0000-0001-8764-2150; YAMAN, Ayhan/0000-0002-5651-1286; Ozdemir, Halil/0000-0002-7318-1688; Leon, Hector Armando Rincon/0000-0003-0715-200X; Delia, Muntean/0000-0001-9100-4530; Atasay, Fatma Begum/0000-0002-9114-5293; Zand, Farid/0000-0003-3489-3372; Kuchenbecker, Ricardo/0000-0002-4707-3683; Medeiros, Eduardo A/0000-0002-6205-259X; ROMERO LOPEZ-ALBERCA, CRISTINA/0000-0001-5856-8668; Salomao, Reinaldo/0000-0003-1149-4598; ozdemir, sonay incesoy/0000-0003-2863-901X; Meco, Basak Ceyda/0000-0003-2951-9634; Horoz, Ozden Ozgur/0000-0001-7590-650X; Horhat, Florin George/0000-0001-6133-0204; Kazi, Mohammad Mukhit/0000-0003-3824-5540; Ciftci, Ergin/0000-0002-4955-160X; Abouqal, Redouane/0000-0002-6117-4341; Leblebicioglu, Hakan/0000-0002-6033-8543; Garcell, Humberto Guanche/0000-0001-7279-0062; Kendirli, Tanil/0000-0001-9458-2803; de Souza, Maria Cecilia B V/0000-0003-0318-3087; Sanaei Dashti, Anahita/0000-0002-2827-3575; UNAL, SERHAT/0000-0003-1184-4711; alvarez Moreno, carlos Arturo/0000-0001-5419-4494; Barahona G., Nayide/0000-0003-3559-6900; Rodriguez Ferrer, Marena Luz/0000-0002-8053-8454; Karabay, Oguz/0000-0003-0502-432X; Kaya, Sehnaz/0000-0003-0002-1517; ERDEVE, OMER/0000-0002-3193-0812; Gonzalez Martinez, Marisela del Rocio/0000-0003-1474-736X; Gikas, Achilleas/0000-0002-8455-9631; Baylan, Orhan/0000-0002-6529-7824; Mitrev, Zan/0000-0001-7859-8821; yildizdas, dincer/0000-0003-0739-5108; Ngo, Quy Chau/0000-0002-6787-2757; Duszynska, Wieslawa/0000-0002-5880-4904; KAYA, ZEYNEP/0000-0002-8468-2103; Dragan, Barbara/0000-0003-3108-4211; Gupta, Umesh/0000-0001-7717-1404; Navarro Fuentes, Karla Reyna/0000-0002-6894-8872; zali, Mohammadreza/0000-0002-9027-4560; Morocho Tutillo, Diego Rolando/0000-0002-4974-7856; El Kholy, Amani/0000-0002-0645-7664; Kanj, Souha/0000-0001-6413-3396; Assiri, Abdullah/0000-0002-5605-2876; Unal, Necmettin/0000-0002-9440-7893; Jayatilleke, Kushlani/0000-0002-3931-6630; KARABAY, OGUZ/0000-0003-1514-1685 WOS: 000341307100001 PubMed: 25179325 We report the results of an International Nosocomial Infection Control Consortium (INICC) surveillance study from January 2007-December 2012 in 503 intensive care units (ICUs) in Latin America, Asia, Africa, and Europe. During the 6-year study using the Centers for Disease Control and Prevention's (CDC) U.S. National Healthcare Safety Network (NHSN) definitions for device-associated health care-associated infection (DA-HAI), we collected prospective data from 605,310 patients hospitalized in the INICC's ICUs for an aggregate of 3,338,396 days. Although device utilization in the INICC's ICUs was similar to that reported from ICUs in the U.S. in the CDC's NHSN, rates of device-associated nosocomial infection were higher in the ICUs of the INICC hospitals: the pooled rate of central line-associated bloodstream infection in the INICC's ICUs, 4.9 per 1,000 central line days, is nearly 5-fold higher than the 0.9 per 1,000 central line days reported from comparable U. S. ICUs. The overall rate of ventilator-associated pneumonia was also higher (16.8 vs 1.1 per 1,000 ventilator days) as was the rate of catheter-associated urinary tract infection (5.5 vs 1.3 per 1,000 catheter days). Frequencies of resistance of Pseudomonas isolates to amikacin (42.8% vs 10%) and imipenem (42.4% vs 26.1%) and Klebsiella pneumoniae isolates to ceftazidime (71.2% vs 28.8%) and imipenem (19.6% vs 12.8%) were also higher in the INICC's ICUs compared with the ICUs of the CDC's NHSN. Copyright (C) 2014 by the Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

A study was carried out to assess treatment success and the overall costs of patients with ventilator-associated pneumonia (VAP). In a prospective case control study, data were collected from 25 intensive care unit (ICU) beds. A total of 162 ICU patients who required mechanical ventilation were assessed. Of these, 81 patients were diagnosed with VAP and the other 81 were controls (without VAP). Risk of mortality was analyzed and total cost of care was recorded. Age, sex and underlying disease were similar between the groups. The mean length of stay (LOS) in the ICUs in the VAP cases (15.7±9.1 days) exceeded that of the controls (4.9±4.9 days) (p 0.0001), and the additional LOS attributable to VAP was estimated at 10.8 days. In the VAP group, 25 patients had early-onset VAP, and the other 56 patients had late-onset VAP. Mortality rates were higher in VAP patients (32%) than controls (19.7%) p 0.05). Total costs were USD 8602.7±5045.5 in the VAP group and USD 2621.9±2053.3 in controls. The additional cost for VAP was found to be USD 5980 per patient. These data suggest that morbidity, mortality, ICU length of stay and costs increase with VAP. The additional costs for VAP are especially based on the use of novel and expensive antibiotics, other drugs, and medical material.

Background This study aims to determine the frequency of maxillary sinusitis in the patients with traumatic head injury and nostrils free of any foreign body. In addition, the sensitivity and specificity of ultrasonography (US) for the detection of the presence of fluid in maxillary sinuses were evaluated. Patients and methods Forty patients with severe traumatic head injury were included in the study. The patients who had displaced maxillary sinus fracture at the medial wall and naso-tracheal and/or naso-gastric tube were excluded. Paranasal computed tomography (CT) was performed along with the routine cranial CT scanning or in case of unknown source of infection and compared with the results of ultrasonographic examination of maxillary sinuses performed by a single radiologist who was unaware of the CT results. In the patients, who had clinical and radiological signs of sinusitis, a trans-nasal puncture was performed using sinoject (SinoJect ® , ATOS Medical, Sweden), a spring-activated puncture instrument, to take a sample for microbiologic examination and to drain maxillary sinuses. Results Eighty-five percent of the patients were tracheotomised on the fifth day (on average) of their intensive care unit (ICU) stay. The frequency of sinusitis in the study group was found to be 32.5% (13 patients). The most frequently isolated species were Pseudomonas spp. (37.5%), Escherichia coli (20.8%) and Peptostreptococcus (16.7%). Five of the aspirates were polymicrobial. The sensitivity, specificity, positive predictive value and negative predictive value of B-mode US, compared with CT for the detection of fluid presence in maxillary sinuses in a 100 maxillary sinus examinations, were 92.2%, 81.6%, 83.9% and 90.9%, respectively. Conclusion Maxillary sinusitis should be considered as a source of infection or sepsis in patients with traumatic head injury because of its high frequency. US is likely to be used as the first-line diagnostic tool for the determination of fluid in maxillary sinuses, especially in patients who do not require CT or cannot be transported to a radiology unit for CT.

Food-borne botulism is a rare disease that results from ingestion of the toxins produced by Clostridium botulinum. The most common cause of the disease is the consumption of home-canned foods prepared under inappropriate conditions, especially in rural environments. In this report, a food-borne botulism outbreak potentially caused by roasted home-canned mushrooms is evaluated and the major reasons for delayed diagnosis are emphasized. The clinical features, symptoms and prognosis of the five botulism patients involved in this outbreak are presented. The clinical progressions, treatments, durations of mechanical ventilation, intensive care unit stays and hospital stays of the three patients admitted to Akdeniz University Hospital are reported.

BACKGROUND Although the clinical examination and documentation of the clinical signs of brain death are very uniform, there are significant differences in the guidelines for using technical confirmatory tests to corroborate the clinical signs. The current study examined the utility of transcranial Doppler ultrasonography (TCD) for confirmation of brain death. METHODS After 19 patients were excluded from the study because of lack of bone window or because an apnea test could not be performed because of desaturation, 100 patients (61 patients with clinical brain death, and 39 control patients with Glasgow Coma Score

Organophosphates are the most common group of chemicals in the southern part of Turkey. Although organophosphate poisoning (OPP) may occur due to skin exposure or inhalation, severe poisoning is usually the result of ingestion to attempt suicide. Despite the fact that there have been a lot of experimental studies using intravenous or percutaneous injection of organophosphates, reports of human poisoning due to percutaneous injection are rare. The systemic signs of OPP have not been described in these reported patients. We report 2 cases having systemic signs of OPP due to percutaneous injection. In our first case, we noticed a 17-day muscle weakness and a 12-day muscarinic syndrome, which required prolonged atropinization. In the second patient, atropine infusion had to be continued for 2 days. Both cases also had severe swelling of the affected limb and wound infection. In conclusion, in cases of percutaneous injection of organophosphates systemic toxicity may develop in addition to local findings such as necrosis and abscesses. Close observation for evidence of systemic involvement is required, and the patient should be carefully monitored for secondary abscess formation and any delayed impairment of neurologic function.

Nattokinase is a serin protease derived from fermentation of boiled soy bean that has a potent fibrinolytic effect [1]. The aim of this experimental study was to investigate the effects of nattokinase on plasma fibrinogen levels, whole blood viscosity and mortality in rats with sepsis.

Introduction We conducted the present study to determine the usefulness of routinely inserting a pediatric airway exchange catheter (PAEC) before tracheal extubation of adult patients who had undergone maxillofacial or major neck surgery and have risk factors for difficult reintubation. Methods A prospective, observational and clinical study was performed in the 25-bed general intensive care unit of a university hospital. Thirty-six adult patients who underwent maxillofacial or major neck surgery and had risk factors for difficult reintubation were extubated after insertion of the PAEC. Results Four of 36 (11.1%) patients required emergency reintubation after 2, 4, 6 and 18 hours after tracheal extubation, respectively. Reintubation of these patients, which was thought to be nearly impossible by direct laryngoscopy, was easily achieved over the PAEC. Conclusion The PAEC can be a life-saving device during reintubation of patients with risk factors for difficult reintubation such as laryngeo-pharyngeal oedema due to surgical manipulation or airway obstruction resulting from haematoma and anatomic changes. We therefore suggest the routine use of the PAEC in patients undergoing major maxillofacial or major neck surgery.

Sinusitis, complication of the head injury in critically ill patients, is an important cause of sepsis and may well be difficult to be diagnosed. In this study, we assayed the sensitivity and specificity of ultrasonography (USG) by comparing it with the computerized tomography (CT) and we determined the incidence of maxillary sinusitis with existing fluid in the maxillary sinuses.

Catheter infection, the most frequent complication of the central venous catheter (CVC), is associated with increased morbidity, mortality and duration of hospital stay. In this study we evaluated the relationship between catheter indwelling time and catheter-related infections. Besides, we searched for the incidence of mechanical complications due to placement of the CVC, the microorganisms responsible for catheter infections and risk factors associated with the catheter infection.

Clinical examination criteria have been established to determine brain death and subsidiary investigations such as electroencephalogram (EEG), arteriography and radionuclide scans have been used to determine the arrest of the cerebral circulation and to confirm the diagnosis of brain death. We examined in this study the clinical utility and reliability of transcranial doppler ultrasonography (TCD) as a confirmatory test for brain death.

Reintubation of the critically ill patients who have risk factors for difficult intubation can be extremely challenging, often resulting in considerable morbidity and mortality. The aim of this study is to determine the usefulness of a pediatric airway exchange catheter (PAEC) prior to tracheal extubation of adult patients who were known to have difficult tracheal intubations and/or have risk factors such as airway obstruction for difficult reintubation.