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Lactate is a product of anaerobic metabolism and increases in states of tissue hypoxia. Furthermore, it is demonstrated that lactate level is correlated with the extent of infarct area and short term (30-day) mortality rates in patients with acute coronary syndrome with ST segment elevation (STE-ACS). Therefore, we aimed to test the prognostic value of this easily obtainable parameter on outcomes in patients presenting with STE-ACS. All adult patients who admitted with STE-ACS between 2019 and 2020 were screened. The cases with admission lactate levels were included. Patients were separated into two groups as low (<2mmol/l) and high (>2mmol/l) lactate groups. A total of 70 patients were enrolled. The mean age of the study population was 62.3 ± 15.0 years and 53 (75.7%) of them were male. The most common infarct related artery was the left anterior descending (LAD) artery. The median lactate level was 2.5 (0.80-15.3) mmol/L. Malignant arrhythmia, contrast induced nephropathy (CIN), and in-hospital mortality rates were not different between the high and low lactate groups. However, all-cause mortality was significantly higher in the high lactate group during the follow-up (p=0.005). Among all included parameters; lactate level [OR:1.76, (CI: 1.28-2.42); p<0.001] and age [OR:1.10, (CI: 1.03-1.17); p=0.004] were predictors for all-cause mortality. Admission lactate level can predict all-cause mortality in patients with STE-ACS. In addition, high admission lactate levels could help to raise more attention even if the patients have been discharged from the hospital. [ABSTRACT FROM AUTHOR]

Purpose: Monitoring the sublingual and oral microcirculation (SM-OM) using hand-held vital microscopes (HVMs) has provided valuable insight into the (patho)physiology of diseases. However, the microvascular anatomy in a healthy population has not been adequately described yet. Methods: Incident dark field-based HVM imaging was used to visualize the SM-OM. First, the SM was divided into four different fields; Field-a (between incisors-lingua), Field-b (between the canine-first premolar-lingua), Field-c (between the first-second premolar-lingua), Field-d (between the second molar-wisdom teeth-lingua). Second, we investigated the buccal area, lower and upper lip. Total/functional vessel density (TVD/FCD), focus depth (FD), small vessel mean diameters (SVMDs), and capillary tortuosity score (CTS) were compared between the areas. Results: Fifteen volunteers with a mean age of 29 ± 6 years were enrolled. No statistical difference was found between the sublingual fields in terms of TVD (p = 0.30), FCD (p = 0.38), and FD (p = 0.09). SVMD was similar in Field-a, Field-b, and Field-c (p = 0.20–0.30), and larger in Field-d (p < 0.01, p = 0.015). The CTS of the buccal area was higher than in the lips. Conclusion: The sublingual area has a homogenous distribution in TVD, FCD, FD, and SVMD. This study can be a description of the normal microvascular anatomy for future researches regarding microcirculatory assessment. [ABSTRACT FROM AUTHOR]

Aim: To determine the prevalence of newly developed low cortisol levels among critically ill medical patients with prolonged or recurrent vasopressor need as well as the factors associated with it. Materials and Methods: This was an observational study which was conducted in a university hospital's medical intensive care unit (ICU) between July 2014 - July 2015. Initial cortisol levels were measured in septic shock patients unresponsive to fluid resuscitation and vasopressors. Patients with initial cortisol levels ≥15 μg/dl were followed; testing was repeated in patients with ongoing/recurrent vasopressor dependency. Patients were grouped as higher (≥15 μg/dl ) and lower (<15 μg/dl) cortisol groups based on repeat testing. Results: Thirty-seven patients had initial cortisol levels ≥15 μg/dl and 19 patients underwent cortisol retesting for ongoing/recurrent vasopressor need. Mean (±SD) age of the patients was 70±13.5 years. APACHE II and Sequential Organ Failure Assessment scores on ICU admission were 25.3±6.5 and 10.4±5.2, respectively. Eleven (%58) were in the lower cortisol group. Age, gender, admission APACHEII and SOFA scores, serum albumin, protein, C-reactive protein and procalcitonin levels at time of admission and repeat sampling were similar between the groups. However, at the time of cortisol retesting, patients with lower cortisol levels had significantly longer length of ICU stay (p=0.038). When glucocorticoid therapy was begun in lower cortisol group, vasopressors were weaned within 48 hours in all. Conclusion: Prolonged or recurrent vasopressor dependency should prompt a search for low cortisol levels in patients with prolonged critical illness, even though prior results were reported to be normal. [ABSTRACT FROM AUTHOR]

Hemophagocytic lymphohistiocytosis (HLH) is a rare and life-threatening syndrome that may be triggered by hereditary factors, autoimmune and immunologic disorders, infectious diseases, malignancies and medications. Suspicion of the disease and early treatment is of paramount importance. Since the presentation of HLH with only skin involvement is rare, early diagnosis may be difficult. A pathologically confirmed HLH case that presented with maculopapular skin lesions after certolizumab treatment is being reported in this presentation. [ABSTRACT FROM AUTHOR]

Objective: Acinetobacter spp are opportunistic pathogens that are commonly isolated in intensive care units (ICU). They are an important pathogen in nosocomial sepsis and ventilator associated pneumonia especially in the ICU's. The most important reason for this is the development of multiple resistance mechanisms. Acinetobacter spp are known to possess resistance mechanisms to diverse antibiotic groups, and recently resistance to colistin has also been observed in our department. Aim of this study was to document frequency and resistance patterns of Acinetobacter spp infections and to study the effect of colistin sensitivity on ICU mortality and length of stay. Material and Methods: Patients who were treated between July 2013 and November 2014 in medical ICU of Ankara Univercity Faculty of Medicine were analyzed retrospectively and patients with Acinetobacter spp. Infections were enrolled. Their age, sex, Acute Physiology and Chronic Health Evaluation (APACHE) II score, admission diagnoses and underlying disease, infection foci, previously used antibiotics, antibiotic resistance patterns of Acinetobacter strains, ICU survival and length of stay were recorded on the database created for the study. Results: During the study period, 134 patients were admitted to ICU. Of them 33 (24.6%) who developed Acinetobacter spp. infection were included. Nineteen of these patients (57.6%) were male. The mean age was 69.39±17.41. All strains were carbapenem resistant, 9 (27.2%) had also colistin resistance. When patients were grouped according to colistin sensitivity of the pathogenic straines, groups were similar in terms of age, APACHE II score, immunosuppression, underlying diseases. And there was no significant difference in survival and length of stay in ICU between the two groups. Conclusion: Acinetobacter spp. infections were observed in patients who were on broad spectrum antibiotics and colistin resistance was observed in patients who had received colistin before. However in the study, no negative effect on survival and ICU length of stay with the colistin-resistant strains was observed. [ABSTRACT FROM AUTHOR]

Hemophagocytic lymphohistiocytosis (HLH) is a rare and life-threatening syndrome that may be triggered by hereditary factors, autoimmune and immunologic disorders, infectious diseases, malignancies and medications. Suspicion of the disease and early treatment is of paramount importance. Since the presentation of HLH with only skin involvement is rare, early diagnosis may be difficult. A pathologically confirmed HLH case that presented with maculopapular skin lesions after certolizumab treatment is being reported in this presentation. [ABSTRACT FROM AUTHOR]

Objective: In this study, we aimed to show the superiority of fused anterior cervical discectomy and fusion (ACDF) with fuseless anterior cervical discectomy by comparing the clinical and radiological follow-up results of patients with ACD and ACDF. Methods: Between 2001 and 2005, 67 patients with cervical disc disease, who underwent anterior cervical intervention, were included in this study. Fifty patients underwent ACD. In 31 cases, cage system and osteoinductive graft material (demineralized bone matrix) were used and 11 cases were treated with plate anterior cervical discectomy in addition to cage system. The mean follow-up period was 12 months (6 months-18 months) in the ACD group. The mean follow-up period in the ACDF group was 12 months (6 months-18 months). All ACD and ACDF patients were evaluated according to the criteria of direct cervical grafillary and Odom criteria taken at the postoperative early period, 6 months and 12 months. Results: Fifty-five patients with ACD and 42 patients with ACDF were included in the study group. The mean age of the patients in the ACD group was 41 years (the youngest was 29, the oldest was 59 years old) and the mean age of the ACDF group was 46 years (the youngest was 30, the oldest was 69 years old). The difference was not statistically significant (p>0.05). There was no decrease in intervertebral disc height and foramen height in patients undergoing ACDF. No kyphosis was seen in ACDF patients. Conclusion: According to the patient group who underwent ACD and ACDF and followed for 24 months, it was seen that the intervertebral disc height, foramen height and cervical lordosis were preserved in ACDF. No intervertebral cage was seen in the cervical corpus in any patient of ACDF. Clinical and radiological findings showed that clinical and radiological outcomes of patients with ACDF were better than ACD patients. The necessity of fusion of the anterior cervical discectomy and the use of instrumentation are discussed in the literature. Because of this reason, the results of our study will be meaningful in terms of contributing to future research. [ABSTRACT FROM AUTHOR]

For vertebral fractures, kyphoplasty appears to be the most innocent treatment modality, but percutaneous injection of kyphoplasty cement might cause serious complications as the injection causes increased venous pressure in paravertebralspace. Here, we report a case of late-onset spinal subdural hemotoma after 6 h of percutaneous balloon kyphoplasty. A 58-year-old female with an acute compression fracture of the second lumbar vertebrae underwent percutaneous balloon kyphoplasty. After 6 h, she had late-onset neurological deficits and leg pain. Emergent lumbar MR was performed. The MR images revealed intraspinal hemotoma. The patient was operated, and spinal subdural hemotoma was removed. Spinal subdural or epidural hemotoma is believed to occur because of increased venous drainage pressure that leads to the rupture of venous vessels following kyphoplasty. These hematomas should be immediately removed, otherwise irreversible neurological complications may occur. [ABSTRACT FROM AUTHOR]

Spinal epidural lipomatosis (SEL) is a rare cause of spinal cord or dural sac compression. It is more common in males and usually affects the thoracic spine. This condition is often a consequence of excessive endogenous corticosteroid production or exogenous steroid administration for various intercurrent systemic diseases. The case histories of two patients suffering from lumbar SEL are reviewed and the management of the patients discussed, we are encouraged to report two cases. They are benign lesions, frequently presenting low back pain or neurogenic claudication, should be considered in the differential diagnosis, in patients with low back pain and radiculopathy. Conservative treatment should be attempted with obesity, steroid use and endogenous steroid disease, provided that there are no neurological deficits. Surgical treatment with SEL is the gold standard in patients with intractable pain or neurological deficit. [ABSTRACT FROM AUTHOR]

Background: There are limited data on the long-term outcomes of COVID-19 from different parts of the world. Aims: To determine risk factors of 90-day mortality in critically ill patients in Turkish intensive care units (ICUs), with respiratory failure. Study design: Retrospective, observational cohort. Methods: Patients with laboratory-confirmed COVID-19 and who had been followed up in the ICUs with respiratory failure for more than 24 hours were included in the study. Their demographics, clinical characteristics, laboratory variables, treatment protocols, and survival data were recorded. Results: A total of 421 patients were included. The median age was 67 (IQR: 57-76) years, and 251 patients (59.6%) were men. The 90-day mortality rate was 55.1%. The factors independently associated with 90-day mortality were invasive mechanical ventilation (IMV) (HR 4.09 [95% CI: [2.20-7.63], P < .001), lactate level >2 mmol/L (2.78 [1.93-4.01], P < .001), age >60 years (2.45 [1.48-4.06)], P < .001), cardiac arrhythmia during ICU stay (2.01 [1.27-3.20], P = .003), vasopressor treatment (1.94 [1.32-2.84], P = .001), positive fluid balance of ≥600 mL/day (1.68 [1.21-2.34], P = .002), PaO2/FiO2 ratio of ≤150 mmHg (1.66 [1.18-2.32], P = .003), and ECOG score ≥ 1 (1.42 [1.00-2.02], P = .050). Conclusion: Long-term mortality was high in critically ill patients with COVID-19 hospitalized in intensive care units in Turkey. Invasive mechanical ventilation, lactate level, age, cardiac arrhythmia, vasopressor therapy, positive fluid balance, severe hypoxemia and ECOG score were the independent risk factors for 90-day mortality. [ABSTRACT FROM AUTHOR]

Cystic meningioma is rare and accounts for 1.6 to 10% of all types of meningioma. Recognition of the diagnostic features of cystic meningiomas is important, because they may be difficult to differentiate from glial or metastatic tumors with cystic or necrotic changes, neuroblastoma, or hemangioblastoma. Different types of cystic meningiomas have been reported by various authors. We detected type 1 cysts in our first and third cases and a type 2 cyst in the second case according to the Nauta classification. Intratumoral cysts may result from cystic degeneration and ischemic necrosis or hemorrhage within the tumor and may be due to a secretory function of the tumor. Here we report three cases of cystic meningiomas and discuss the characteristics of these lesions with the studies found on Pubmed search. [ABSTRACT FROM AUTHOR]