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Background: PE accounts for 3% of out-of-hospital cardiac arrest. In this case, treating patients with thrombolysis during resuscitation has been associated with better survival. Objective: The aim of this study is to evaluate the use of systemic thrombolytic in unstable and/or resuscitated patients who are evaluated in the red area in emergency service practice and who are diagnosed with massive pulmonary embolism with bedside examinations. Methods: This prospective study was designed on 17 patients who were transferred as unstable to the emergency service of a tertiary hospital by Emergency Health Services and/or who needed resuscitation due to non-shockable fatal rhythm disorder on admission and who underwent systemic thrombolysis due to the diagnosis of pulmonary embolism during resuscitation. Results: Of the 17 patients included in the study, 52.9% were discharged and improvement was detected in unstable vital findings in 47.1% patients after thrombolysis. Of the bedside examinations performed on admission, ECG showed T wave negativity at V1-4 deviations and P-pulmonale in 41.2% patients and ECHO showed right ventricle dilatation indicating right ventricle dysfunction in 82.4% patients. CTPA taken after stabilization showed thrombus at bilateral pulmonary artery in 88.2% patients. Conclusion: Cardiopulmonary arrest caused by PE is a life-threatening condition that requires urgent systemic thrombolysis. Patients who are evaluated as unstable or in need of resuscitation in the emergency service should be diagnosed quickly as a result of examinations performed at bed-side and thrombolytic treatment should be started.

Background/Aim: It has been reported that the prognostic nutritional index (PNI) is ), an immunonutritional index, associated with poor prognosis, especially in cardiovascular and malignant diseases. However, the clinical significance of PNI in intensive care (ICU) patients remains unclear. In this study, we aimed to measure the predictive value of the PNI in predicting mortality in patients hospitalized in the ICU.Methods: A total of 80 patients hospitalized in the internal medicine ICU of our hospital between January 2021 and September 2021 were included in this observational cohort study. The patients' demographic characteristics, comorbidities, laboratory parameters, need for and duration of mechanical ventilation, length of stay in ICU, and mortality rates were retrospectively analyzed. The patients were divided into two groups according to their survival; the first group comprised of survivors while the second group comprised of those who died in the ICU. The two groups were compared in terms of all variables.Results: The mean age of all subjects included in the study was 63 (18.2) years and 50% (n=40) were female and 50% (n=40) were male. When patients are grouped as survivors and non-survivors, the mean age and sex distribution were similar (P=0.23, P=0.27, respectively). The median follow-up period of the patients was 5 (IQR 3-11) days and the mortality rate was 38.7% (n=31). Those in the non-survivor group had higher APACHE II and SOFA scores (P=0.02, P

Purpose: To determine the quality and reliability of the information about sepsis on the internet.Material methods: The quality and reliability of the information on the websites accessed through the most frequently searched words about sepsis were evaluated with the JAMA Benchmark Criteria and the DISCERN scoring system. Data accuracy was compared with the Surviving Sepsis Campaign guidelines. Results: The search terms used resulted most frequently (36,5%) in information from private hospitals. Only 4 of the 63 sites related to sepsis search terms met all 4 JAMA criteria. The JAMA Benchmark score was found to be median 21.18 (min:0- max:4). Of the sites, 74,6% showed an update date. Only 31.7% of the sites examined had expert or author information. The mean DISCERN score was calculated as 368.51 (min 16-max 59). According to these results, the quality and reliability of internet-sourced information on sepsis was poor. Discussion: The provision of health information on the internet, mostly by private hospitals, may lead to ethical problems. Missing or erroneous information may delay medical treatment, whereas good quality medical information can be effective in reducing unnecessary medical expenses and hospital admissions. Conclusion: The quality and reliability of information about sepsis and related search terms on the Internet were low. It was concluded that public instutions and academic institutions should play a more active role in providing patients with accurate information., Amaç: Bu çalışmanın amacı sepsis konusunda internetten elde edilen bilgilerin kalitesi ve güvenilirliği sorgulamaktırMateryal ve Metod: Sepsis ile ilgili en sık aranan kelimeler üzerinden, erişilen web sitelerindeki bilgilerin kalitesi ve güvenilirliği JAMA Benchmark Kriterleri ve DISCERN skorlama sistemi ile değerlendirildi. Verilerin doğruluğu Sepsiste Sağkalım Kampanyası klavuzları ile kıyaslandı. Bulgular: En sık özel hastaneler arama terimleriyle ilgili olarak sonuçlar ekranına geliyordu (% 36.5). Sepsis arama terimiyle ilgili 63 siteden sadece 4'ü 4 JAMA kriterini de karşıladı. Tüm siteler için median JAMA Benchmark skorunun 2±1.18 (min: 0- maks: 4) olduğu bulundu. Güncelleme tarihi mevcut sitelerin oranı % 74.6 idi. Çalışmamızda incelediğimiz sitelerin yalnızca % 31,7'si uzman veya yazar bilgilerine sahipti. DISCERN skoru ortalama 36±8.51 (min 16-maks 59) olarak hesaplandı. Bu sonuçlara göre internet kaynaklı bilgilerin kalitesinin ve güvenilirliğinin zayıf olduğu görülmüştür.Tartışma: Sağlık bilgilerinin çoğunlukla özel hastaneler tarafından internet üzerinden sağlanması etik sorunlara yol açabilir. Eksik veya hatalı bilgiler tıbbi tedaviyi geciktirebilir. Ayrıca kaliteli tıbbi bilgiler, gereksiz tıbbi harcamaları ve hastaneye yatışı azaltmada etkili olabilir. Sonuç: İnternette sepsis ve ilgili arama terimleri hakkındaki bilgilerin kalitesi ve güvenilirliği düşüktü. Kamusal ve akademik kurumların hastalara doğru bilgi sağlamada daha aktif bir rol oynaması gerektiği sonucuna varıldı.

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.

Objectives: Hip Fractures (HF) affect the elderly in particular, and are associated with high mortality rates. Most geriatric patients are admitted to Intensive Care Unit (ICU) after HF surgery. In this study, the purpose was to investigate the prognostic value of preoperative NLR (Neutrophil-to-Lymphocyte Ratio) on postoperative ICU admission and mortality in elderly patients with HF. Methods: In the present study, the data of 188 geriatric patients who underwent surgery because of isolated HF (i.e. femur neck and intertrochanteric fracture) were examined retrospectively. The patients over 65 years of age, ASA score 3/4, whose preoperative duration was less than 72 hours, and who underwent spinal anesthesia were included in the study. The patients were divided into two groups as ICU admission (ICU, n = 58), and Non-ICU (Non-ICU, n = 130). The patients were also grouped as Survival (n = 168) and Non-survival (n = 20) according to postoperative mortality rates. NLR values were statistically compared between the groups. Results: The preoperative NLR values of the patients in the ICU Group were significantly higher than those in the Non-ICU Group (p < 0.001). The cut-off value of NLR for ICU admission was found to be 9.65 with 89% sensitivity and 67% specificity in the ROC analysis. The median NLR value was 6.42 (3.55-9.44) in the Survivor Group, and 9.5 (7.23-11.02) in the Non-Survivor Groups (p = 0.015). Conclusions: It was shown in the study that high NLR values in elderly patients may be a risk factor for ICU admission, and for postoperative mortality after HF.

Background/Aim: Acute kidney injury (AKI) is a common serious complication associated with morbidity and mortality in critically ill COVID-19 patients. Although there is very limited data on the incidence of AKI in this cohort, conflicting results were recently reported. The incidence of AKI in critically ill COVID-19 patients ranged between 0.5-50% in the early studies. This study aimed to evaluate the incidence and determine the demographic parameters, clinical courses, and outcomes of AKI in critically ill COVID-19 patients admitted to the intensive care unit (ICU).Methods: After ethics committee approval was obtained, critically ill COVID-19 patients admitted to our ICU between June 1- December 30, 2020, were analyzed in this retrospective cohort study. Patients over the age of 18 years who were admitted to the intensive care unit with the diagnosis of COVID-19 or whose real-time polymerase chain reactions (RT-PCR) test were positive were included in the study. Incidence and stages of AKI among the included critically ill COVID-19 patients were evaluated. The patients were divided into two groups according to the presence of AKI to define the risk factors and clinical outcomes. AKI was defined according to the Kidney Disease Improving Global Outcomes (KDIGO) guidelines based on serum creatinine and urine output. Results: We analyzed seventy-four critically ill confirmed COVID-19 patients. The mean age was 70.7 (14.8) years and 63.5% were male. Thirty-four patients (45.9%) had AKI, 12 patients in stage I (16.2%), 13 patients in stage II (17.6%), and 9 patients in stage III (12.1%). Renal replacement therapy (RRT) was initiated in 28.4% of patients with AKI; 16.2% received intermittent hemodialysis and 12.2%, continuous renal replacement therapy. APACHE II score and GCS at ICU admission were similar in patients with or without AKI (P>0.05), but the SOFA score was significantly higher in patients with AKI (P=0.03). ARDS and shock were significantly higher in patients with AKI than without (P=0.01 and P=0.039, respectively). Compared to the patients without AKI, those with AKI required higher amounts of oxygen therapy (high-flow oxygen therapy, non-invasive mechanical ventilation) and invasive mechanical ventilation (P=0.01 and P

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.

Objectives: An exaggerated inflammatory immune response is observed in cases of COVİD 19. This study aims to evaluate the effects of vitamin C, as a significant modulator of inflammation, on the inflammatory parameters and mortality in patients followed up in the intensive care unit (ICU) during the pandemic. Methods: This single-center retrospective study included 160 adult patients with confirmed positive nasopharyngeal smear COVID-19 PCR test results, who were followed up in the ICU between 01 March and 01 August 2020. Hospital files were scanned and patients given and not given vitamin C were assigned, to Group 1 and Group 2, respectively. The Acute Physiology and Chronic Health Evaluation (APACHE II) scores, the data entries on demographics, ventilation, laboratory tests, duration of ICU stay, discharge, and mortality were compared. Interventions with antiviral and antibacterial agents. steroids, cytokine apheresis, and renal replacement therapy were evaluated. Results: Vitamin C treatment was started in patients with raised neutrophil/lymphocyte ratio (NLR) at admission to ICU, who made up 20% of the total 160 ICU patients. Mortality incidence was higher among patients with raised NLR. Vitamin C at the doses used did not affect the inflammatory parameters, length of stay or mortality, and 37.5% of the patients recovered and were discharged from the ICU. Conclusions: We think that vitamin C treatment will have positive effects on the initiation of COVID-19 and that the time of intiation of the therapy and the optimal doses used should be determined with prospective studies.

Amaç: Bu çalışmda yoğun bakım hastalarında enerji tüketimini etkileyen parametreleri ve enerji tüketiminin hesaplanması için en güvenilir formüllerin belirlenmesi amaçlanmıştır. Gereç ve Yöntem: Bu prospektif çalışma Çukurova Üniversitesi Hastanesi İç Hastalıkları Anabilim Dalı yoğun bakım ünitesinde yapıldı. Çalışmaya, hemodinamik ve solunum stabilitesi olan, mekanik ventilatörde 24 saatten fazla izlenen 18 yaş üstü toplam 71 hasta dahil edildi. Formüllerden elde edilen hesaplanan enerji tüketim değerlerinin, indirekt kalorimetre ile ölçülen enerji tüketim değerleri ile korelasyonunu inceledik. Bulgular: Çalışma 71 hasta üzerinde gerçekleştirildi. Hastaların ortalama enerji tüketimi 2078 ± 794 kcal ve kilogram başına ortalama enerji ihtiyacı 31.64 ± 13.82 kcal olarak bulundu. İndirekt kalorimetre ölçümleri Swinamer formülü ile en güçlü korelasyonu gösterdi. Sonuç: İndirekt kalorimetri, enerji tüketiminin belirlenmesinde sadece "altın standart" değil, "ulaşılabilir altın standart" haline geldi. Yoğun bakım hastalarında beslenmenin doğru şekilde sürdürülmesi için indirekt kalorimetre yönteminin kullanılmasını öneriyoruz. İndirekt kalorimetrenin kullanılamadığı veya 24 saat beklemenin istenmediği koşullar altında; 2 saatlik bir ölçümün sonuçlarına göre veya güvenilir tahmin denklemlerine göre besleme başlatılabilir., Purpose: The aim of this study was to determine parameters affecting the energy consumption in intensive care patients, and the most reliable formulas for calculation of energy consumption.Materials and Methods: This prospective study was carried out in the intensive care unit of the Internal Medicine Department of Çukurova University Hospital. Total 71 patients above 18 years of age, with hemodynamical and respirational stability, and being followed up on a mechanical ventilator for more than 24 hours, were included to this study. We analyzed the correlation of calculated energy consumption values obtained from formulas, with the energy consumption values measured by indirect calorimeter. Results: The study was executed on 71 patients. The mean energy consumption of the patients was 2078±794 kcal and the mean energy need per kilogram was found as 31.64±13.82 kcal. Indirect calorimeter measurements showed the strongest correlation with Swinamer formula.Conclusion: Indirect calorimetry has become not only a "gold standard" but an "achievable gold standard" in determining energy consumption. We recommend that the indirect calorimeter method should be used in intensive care patients to maintain nutrition properly. Under conditions where indirect calorimeter cannot be used, or it is not desirable to wait for 24 hours; feeding can be started according to the results of a 2-hour measurement, or reliable predictive equations.

Amaç: Çalışmamızın amacı, yoğun bakım ünitesinde (YBÜ) sepsis nedeniyle yatan hastalarda nötrofil lenfosit oranı (NLO), monosit lenfosit oranı (MLO) ve trombosit lenfosit oranı (TLO mortaliteyi belirlemedeki prognostik değerini araştırmaktır. Gereç ve Yöntem: Çalışmamızda, Şubat 2017 – Nisan 2018 tarihleri arasında YBÜ’de yatan tüm sepsisli hastalar retrospektif olarak değerlendirilmiştir. Hastaların demografik ve klinik özelliklerine ek olarak tam kan sayımı parametreleri kayıt edildi. Mortalite olan ve olmayan sepsisli hastaların başlıca NLO, MLO ve TLO sonuçları olmak üzere demografik ve klinik özellikleri ile diğer laboratuvar sonuçları karşılaştırıldı. Bulgular: Çalışmaya 411 hasta dahil edildi. Sepsisli hastaların %55,7’si (229/411) öldü ve %44,3 hasta (182/411) sağ taburcu edildi. Mortalite olan grupta yaşayan gruba göre NLO, MLO ve TLO daha yüksek bulundu. Sepsisli hastalarda mortalite tahmini için eşik NLO için ≥9,2, MLO için ≥0,8, TLO için ≥187,3 olarak bulundu. Nötrofil lenfosit oranı için eğri altında kalan alana (AUC) değeri 0,825, MLO için AUC değeri 0,835 ve TLO için AUC değeri 0,720 olarak bulundu. Sonuç: Yoğun bakım ünitesinde yatan sepsis hastalarında yüksek NLO, MLO ve TLO değerleri mortalite ile ilişkili olup, üç oran arasından mortalite göstergesi için en anlamlı parametre AUC değeri en yüksek olan MLO olarak bulundu., Purpose: The aim of our study is to investigate the prognostic value of Neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), and platelet-to-lymphocyte ratio (PLR) in determining mortality in patients hospitalized for intensive care unit (ICU) sepsis.Materials and Methods: This study retrospectively evaluates all patients hospitalized with sepsis in our ICU between February 2017 and April 2018. In addition to the demographic and clinical characteristics of the patients, complete blood count parameters were also recorded. Demographic and clinical characteristics, mainly NLR, MLR and PLR results, and other laboratory results of patients with sepsis were compared between the ones with and without mortality. Results: Four hundred and eleven patients were included in the study. 55.7% (229/411) of patients with sepsis died and 44.3% (182/411) were discharged alive. NLR, MLR and PLR were higher in the group with mortality compared to the survivor group. The cut-off value for predicting mortality in patients with sepsis was 9.2 for NLR, ≥0.8 for MLR, and ≥187.3 for PLR. The area under the curve (AUC) value for NLR was 0.825, the AUC value for MLR 0.835 and the AUC value for PLR was 0.720.Conclusion: High NLR, MLR and PLR values are associated with mortality in sepsis patients hospitalized in ICU, and the most significant parameter for mortality indicator among the three rates was found to be MLR with the highest AUC value.

Background/Aim: Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has resulted in a pandemic. Early diagnosis of complications and mortality caused by this disease will guide the treatment process in patients with COVID-19. We aimed to investigate whether the neutrophil/lymphocyte and fibrinogen/albumin ratios can predict mortality in COVID-19 patients.Methods: A total of 102 adult patients (≥18 years) who were followed up in the intensive care unit (ICU) between May and August 2020 because of COVID-19 were included in this retrospective cohort study. Demographic data, comorbid diseases, and hematological parameters of the patients during admission to the ICU were examined. Hematological parameters such as leukocyte, neutrophil, lymphocyte, platelet counts, C-reactive protein (CRP), D-dimer, and lactate data were recorded. The neutrophil-to-lymphocyte ratio (NLR) and fibrinogen-to-albumin ratio (FAR) were calculated, and their effects on mortality were examined.Results: Of the patients, 71 (69.6%) were male and the mean age of all patients was 69.1 (14.3) (24–103) years. Comorbid diseases of the patients were as follows: Hypertension (n=40, 39.2%), diabetes mellitus (n=28, 27.4%), chronic obstructive pulmonary disease (n=20, 19.6%), coronary artery disease (n=14, 13.7%), heart failure (n=4, 3.9%), and cerebrovascular disease (n=3, 2.9%). Mortality was higher in older patients (median age = 72; range = 62–80 years) (P=0.043), and bilateral infiltration was observed in lung computed tomography images of all patients who died. Mortality was higher in patients with NLR>9.16, FAR>0.15, D-dimer>2.01 mg/L, CRP >11.6 mg/dL, lactate >2.3 mmol/L.Conclusion: Elevated levels of neutrophil-to-lymphocyte Ratio, fibrinogen-to-albumin ratio, D-dimer, CRP, and lactate were associated with worse outcomes among COVID-19 patients in the ICU.

Background: Emergency deparment (ED) has an important role at the care of nursing home residents and acts facilitator role at the acute care, admission to the hospital, unexpected injuries and hospitals. Our research is aiming the evaluation of the demographic and clinical features of the nursing home patients applying to ED. Materials and methods: The nursing home residents who are aged 18 and over 18 applying to ED at the date between 15.04.2014-15.05.2015 are included to this respective study. In the study, demographic information of the patients and diagnosis and treatment information in the emergency room were evaluated. Results: 51 (52%) of the patients are male. The average age of them is 73. The most frequent disease observed in their medical history is Alzheimer’s disease. The physical examinations of the patients resulted that they have cachexia and dehydration. The oftenest diagnosises detected are lung disease (23.5%), infection (22.4%) and malnutrition (22.4%). It has been also detected that 45% of them admitted to hospital and 3.1% of them are to die. The rate of intensive care admission is 64% while the service admission rate is 36%. Conclusion: The rate of the admission of the nursing home residents to ER and especially to intensive care units is quite high. To ameliorate this condition, training and supervision of the nursing home workers should be made more carefully and often. Since we do not have sociodemographic and clinical data about the nursing home residents applying to ED, more study must be made about this area., Giriş: Acil servis, huzurevi sakinlerinin bakımında önemli role sahiptir; beklenmedik hastalık ve yaralanmalarda, akut bakımda, hastaneye yatışlarda kolaylaştırıcı bir rol oynar. Araştırmamız acil servise başvuran bakımevi hastalarının demografik ve klinik özelliklerinin değerlendirilmesini amaçlamaktadır.Gereç-Yöntem: Bu retrospektif çalışmaya 15.04.2014-15.05.2015 tarihleri arasında hastanemiz acil servisine başvuran 18 ve yaş üzerindeki huzurevi ve özel bakım merkezlerinde kalan hastalar dahil edilmiştir. Araştırmada hastaların demografik bilgileri ile acil servisteki tanı, tedavi bilgileri değerlendirildi.Bulgular: Hastaların 51’i (%52) erkek, 47’si (%48) kadındı. Yaş ortalaması 73’tü. Hastaların özgeçmişlerinde en sık tespit edilen hastalık Alzheimer hastalığı idi. Hastaların %24’ünün fizik muayenesinde kaşeksi ve dehidratasyon tespit edildi. En sık tanılar akciğer hastalığı (% 23,5), enfeksiyon (%22.4) ve beslenme bozukluğu idi (% 22,4).Hastaların %45’inin hastaneye yatırıldığı ve %3,1’inin de eksitus olduğu saptanmıştır. Yoğun bakım yatışlarının oranı %64, servis yatışlarınınki ise %36 idi.Sonuçlar: Bakımevi hastalarında acil servisten hastaneye ve özellikle yoğun bakıma yatış oranları daha yüksektir. Bunun düzeltilebilmesi için bakım evinde çalışan personelin gerekli eğitimlerinin daha özenli yapılması ve denetimlerinin sıklaştırılması gerekmektedir. Acil servise başvuran bakım evi hastalarının sosyodemografik ve klinik özellikleri ile ilgili olarak ülkemizde veri olmaması nedeniyle daha fazla çalışmaya ihtiyaç vardır.

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: Thrombocytopenia is a common hematological abnormality among patients in the intensive care unit (ICU). The development of thrombocytopenia in the ICU usually indicates severe organ system dysfunction rather than a primary hematological disorder. We aimed to determine the incidence, causes, and clinical results of thrombocytopenia in patients followed up in ICU. Methods: In this retrospective cohort study, 165 patients who were followed up in the ICU with thrombocyte counts below 150,000 /uL were included and causes of thrombocytopenia, along with its effects on mortality and intensive care stay were investigated. Results: Thrombocytopenia was determined in 30.1% of the patients in the ICU. The cause of thrombocytopenia was sepsis in 33 (20.0%) of the patients and disseminated intravascular coagulation (DIC) in 20 (12.1%) patients. During the study period, 115 (69.7%) of 165 thrombocytopenic patients and 173 (45.1%) of 383 patients without thrombocytopenia died. Mortality was significantly higher in patients with thrombocytopenia. Mortality significantly increased when platelet count decreased, even with similar APACHE II scores. Conclusion: The most common causes of thrombocytopenia in the ICU were sepsis and DIC. Thrombocytopenia is common in the ICU and increases mortality rates.

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

Introdução: A Covid-19 é considerada a mais recente pandemia que se espalhou na maioria dos continentes, resultando em um grande número de mortes em um curto período de tempo. A infecção pelo coronavírus pode levar a uma gama de manifestações clínicas graves que podem aumentar significativamente o número de internações hospitalares e ter como consequência a super lotação de Unidades de Terapia Intensiva (UTI). Assim devido a complexidade dos pacientes em decorrência das disfunções orgânicas derivadas da doença, a probabilidade de ocorrer complicações durante a estadia na UTI pode aumentar os dias de internação, levando a piora das condições clínicas e a necessidade de reabilitação. Objetivo: Analisar os fatores relacionados ao tempo de internamento de pacientes internados na UTI COVID-19. Método: Trata-se de um estudo transversal, com abordagem quantitativa, realizado junto a pacientes que foram internados na UTI adulto COVID-19, no interstício de março de 2020 a abril de 2021, em um hospital público de ensino, referência para tratamento da COVID-19, na 3ª Regional de Saúde e zona Leste do estado do Paraná, Brasil. Para coleta de dados utilizou-se o prontuário eletrônico dos pacientes (G-SUS), tabulados no software Microsoft Excel 2013® e analisados descritivamente por meio de frequência absoluta e relativa, médias e desvio padrão e pelo teste de regressão linear ao nível de significância de 95%. Considerou-se como variável dependente o tempo de internação e como variáveis independentes o sexo, idade, desfecho clínico e ano que ocorreu o internamento na UTI COVID-19. O estudo foi aprovado pelo comitê de ética e pesquisa com seres humanos (CAAE: 31524820.9.0000.0105). Resultados: A amostra foi composta em sua maioria por homens (57,49%), com idade média de 59,94 anos (18 ±98) que vieram a óbito (54,93%) e que foram hospitalizadas no ano de 2021 (62,32%). Em relação ao tempo de internação na UTI COVID-19, a média foi de 11,76 dias, com variações de 0 a 108 dias. Quando associadas, a idade teve relação negativa com o tempo de internação, a cada ano reduziu-se em média 0,13 (-0,22-0,047) o tempo de internação (p=0,002). Ainda, o desfecho clínico e o ano de hospitalização também estiveram relacionados ao tempo de internação, pacientes que vieram a óbito e que internaram em 2021 apresentaram maior tempo de internação (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: Transplantation processes were impacted worldwide due to the COVID-19 pandemic. The present study investigates brain death and cadaveric organ donation during the pandemic at a large referral hospital in Turkey. Methods: All brain death cases diagnosed between 11.3.2020 and 11.3.2021 in our center were retrospectively evaluated. Patient data were analyzed, including demographic characteristics, family consent rates, and additional COVID-19 tests for donor eligibility. In addition, declaration and donation times, the number of donors, and the usability of organs were studied. Furthermore, the patients whose organs could not be used despite family consent were considered regarding the medical reasons for that outcome. Results: 26 adult brain death cases were included in the study. Family consents were granted in seven (26.9%) patients. The organs of three of the seven cases with family consent were transplanted. In one of the remaining four, the second RT-PCR test was positive. In the other ones, both RT-PCR tests were negative, but COVID-19 could not be ruled out through laboratory tests and chest tomography, and bactere-mia were evident in blood cultures. The non-donor’s lymphocyte count (0.665 ×109/L [0.340-0.770]) was significantly lower than that of donor (1.182 ×109/L [1.050-1.780]) (p

Objective: The aim of this study was to determine risk factors to predict the duration of tachypnea in the management of infants hospitalized with transient tachypnea of newborns (TTN). Methods: This prospective study included newborns diagnosed with TTN separated into two groups of those with tachypnea lasting 72 hrs (Group 2). The two groups were compared in respect of clinical and laboratory findings.Results: The newborns in Group 1 were observed to have a lower birth weight and lower gestational age, and higher rate of SGA. These infants were determined to have a higher rate of antenatal steroid administration, longer duration of ventilation, and longer hospital stay. The cord blood gas oxygen levels and TSH levels were lower, and the hemogram parameters of WBC and PCT levels were significantly higher in Group 1.Conclusions: Assessment of cord blood gas oxygen levels may be useful in predicting the clinical course of TTN.

We have read the research titled “Analysis of Patients with Pulmonary Thromboembolism Who Received Thrombolytic Therapy in The Emergency Department” prepared by Emektar et al. with great interest. We thank the authors and the editorial board for publishing this successful and informative paper contains data of patients presented on pre-pandemic period. The patient profile has also changed with the spread of SARS-CoV-2 worldwide. We also would like to mention a few important points about mechanism of pulmonary embolism in SARS-CoV-2 infection.

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.

Purpose: The study was conducted to investigate the effect of nature-based sound therapy on patients during the separation from mechanical ventilator in a surgical intensive care unit.Materials and Methods: This randomized was controlled experimental study conducted with 64 patients. The patients was divided into two groups as experiment (n =34) and control (n =34) group. Before separating from the ventilator, the eyes in the experimental group were closed and 30 minutes of nature-based sound therapy was applied. Patients' arterial systolic and diastolic blood pressures, heart rate, respiratory counts, oxygen saturation values, pain at both 0th and 30th minutes before and after each interventions and the 0th, 10th, 20th and 30th minutes of seperation from the ventilator, and anxiety levels were compared. Data were collected by personal information form, survey form, Face Pain Scale, Glaskow Coma Scale, Modified Smiley Face Scale, and Richmond Agitation-Sedation Scale.Results: Clinical and statistically significant differences were found in the patients in the experimental and control groups for mean systolic and diastolic blood pressures, heart and respiration rates, administration methods and measurement times. Pain, agitation and anxiety levels of the experimental group were found clinically and significantly lower than the control group.Conclusion: Nature-based sound therapy applied in the process of separating the surgical patients from the intensive care unit from the mechanical ventilation support is effective in maintaining the arterial blood pressure, heart rate and respiratory rate in the normal range, and reducing the pain and anxiety., Amaç: Araştırma, cerrahi yoğun bakım ünitesinde yatan hastaların mekanik ventilasyondan ayırma sürecinde uygulanan doğa temelli ses terapisinin etkisini incelenmek amacıyla yapıldı.Gereç ve Yöntem: Bu randomize kontrollü deneysel araştırma 64 hasta ile yapıldı. Hastalar deney (n=34) ve kontrol (n=34) grubu olmak üzere ikiye ayrıldı. Ventilatörden ayırmadan önce deney grubundaki gözleri kapatıldı, 30 dakika doğa temelli ses terapisi uygulandı. Her iki uygulama öncesi ve sonrası hastaların arteriyel sistolik ve diyastolik kan basınçları, kalp atım hızları, solunum sayıları, oksijen satürasyonu değerleri, ağrı ve anksiyete düzeyleri karşılaştırıldı. Veriler; kişisel bilgi formu, veri kayıt formu, Yüz Ağrı Skalası, Glaskow Koma Skalası, Modifiye Edilmiş Gülen Yüz Skalası, Richmond Ajitasyon-Sedasyon Skalası ile toplandı. Bulgular: Deney ve kontrol grubundaki hastaların ortalama sistolik ve diyastolik arteriyel kan basınçları, kalp atım hızları ve solunum hızları, uygulama yöntemlerine ve ölçüm zamanlarına göre elde edilen bulguların, klinik ve istatistiksel açıdan anlamlı farklılık gösterdiği belirlendi. Deney grubunun ağrı, ajitasyon ve anksiyete seviyelerinin, kontrol grubuna göre klinik açıdan anlamlı olarak düşük olduğu belirlendi.Sonuç: Bulgularımız, yoğun bakımda yatan cerrahi hastalarını mekanik ventilasyon desteğinden ayırma sürecinde uygulanan doğa temelli ses terapisinin arteriyel kan basıncının, kalp atım hızının ve solunum sayısının normal sınırlarda sürdürülmesinde, ağrı ve anksiyetenin azaltılmasında etkili olduğunu göstermiştir.

Giriş ve Amaç: Non-invaziv yöntemle parmaktan oksijen saturasyonu takibi, acil servis ve peroperatif dönemde yapılması gereken önemli bir hasta takip yöntemidir. Tırnak cilasının mevcut olması genellikle istenmeyen bir durumdur. Bu çalışma, tırnak cilasının periferik oksijen saturasyonu ve perfüzyon indeksi üzerindeki etkisi değerlendirmek üzere planlandı.Gereç ve Yöntemler: Bu çalışma 3. Basamak Üniversite Hastanesi Acil servisinde sigara içmeyen, 18 yaş ve üzeri olan 80 sağlıklı gönüllü üzerinde prospektif olarak yapıldı. Oksijen saturasyonunu en çok etkileyen, spektrofotometre absorbansı en büyük farkı gösteren koyu mavi tırnak cilası sürülerek parmak probe ve perfüzyon indeks cihazındaki oksijen saturasyon değeri ve perfüzyon indeks değeri ölçülüp kaydedildi.Bulgular: Probe ile bakılan ojesiz grubun ortalama SPO2 düzeyi, ojeli gruptan ortalama 1,48 birim yüksekti. PI ile bakılan SPO2 düzeyi 1,18 birim daha yüksek saptandı. Ojesiz grubun ortalama PI düzeyi, ojeli gruptan ortalama 0,51 birim daha düşük olarak saptandı (p, Objective: Finger oxygen saturation monitoring with a non-invasive method is an important patient follow-up method thats hould be performed in the emergency room and peroperative period. The presence of nail polish is generally undesirable. This study was planned to evaluate the effect of nail polish on peripheral oxygen saturation and perfusion index.Materials and Methods: This study was conducted prospectively on 80 non-smoking healthy volunteers, aged 18 years and over in the 3rd Level University Hospital Emergency Department. Oxygen saturation value and perfusion index value in finger probe and perfusion index device were measured and recorded by applying dark blue nail polish, which affects oxygen saturation the most and shows the greatest difference in spectrophotometer absorbance.Results: The mean SPO2 level of the nail polish-free group with the probe was 1.48 units higher than the nail polish group. SPO2 level measured with PI was 1.18 units higher. The mean PI level of the nail polish-free group was 0.51 units lower than the group with nail polish. (p

Ateş; yetişkin yoğun bakım ünitelerine (YBÜ) kabul edilen hastalarda en sık saptanan anormal belirtilerden biridir ve kritik hasta popülasyonlarında artan mortalite ile ilişkilidir. Yoğun bakım ünitesinde ateş, önemli tanı ve tedavi kararlarını etkilemektedir. Genellikle erken döneminde ortaya çıkar, sıklıkla enfektif değildir ve genellikle iyi huyludur. Yoğun bakım ünitesindeki ateş enfeksiyöz ve enföksiyöz olmayan nedenlerden kaynaklı olabilir. Tedavinin temel taşı, ateşin altında yatan nedeni tedavi etmektir. Klinisyenin yoğun bakımda kritik hasta takibinde uygun vücut ısısı ölçümüne, tanısal değerlendirmeye, kalıcı kateterlerin değiştirilmesine, ateş düşürücü ilaçların uygulanmasına ve antibiyotik tedavisine, değişikliğe dikkat edilerek ateşin tanımlanması ve tedavisine yönelik en iyi kanıta dayalı yaklaşımın literatür analizi yoluyla belirlenmesine ihtiyaç vardır., Fever; is one of the most common abnormal symptoms in patients admitted to adult intensive care units (ICUs) and is associated with increased mortality in critically ill populations. Fever in the critical care unit affects important diagnosis and treatment decisions. It usually occurs early, is often non-infective, and is usually benign. Fever in the intensive care unit can be caused by infectious and non-infectious causes. The cornerstone of treatment is to treat the underlying cause of the fever. There is a need for the clinician to determine the best evidence-based approach for the identification and treatment of fever by paying attention to appropriate body temperature measurement, diagnostic evaluation, replacement of indwelling catheters, administration of antipyretic drugs, antibiotic therapy in critical patient follow-up in the intensive care unit, through literature analysis.

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.

Amerika- Avrupa Konsensus Konferans Komitesi tanımına göre “akut solunum sıkıntısı sendromu”(ARDS) göğüs radyolojisinde akut başlangıçlı yaygın bilateral pulmoner infiltratlar, arteriyel oksijen/fraksiyon parsiyel basıncı (PaO2/FiO2) “akut akciğer hasarı”(ALI) için ≤300 mmHg ve ARDS için ≤200 mmHg ve pulmoner arter oklüzyon basıncı, According to the definition of American- European Consensus Conference Committee ARDS requires the acute onset of diffuse bilateral pulmonary infiltrates by chest radiograph; a partial pressure of arterial oxygen/fraction of inspired oxygen (PaO2/FiO2) ≤300 mmHg for ALI and ≤200 mmHg for ARDS; and a pulmonary artery wedge pressure

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]

HHV-8 is associated with Kaposi sarcoma, multicentric Castleman disease and primary effusion lymphoma mostly in immunocompromised patients. in this report, we describe a female patient without any immunosuppressive state, encountering those three malignancies throughout her lifetime. A-69-year-old female patient was diagnosed with Kaposi sarcoma in 2009 and multicentric Castleman disease in 2011. She received several chemotherapy regimens during 4 years and stayed in remission during following 5 years. Then, she was diagnosed with primary effusion lymphoma, extracavitary/solitary variant on excisional biopsy of her cervical lymphadenopathy. Despite having 5 different lines of chemotherapy protocols, including autologous stem cell transplantation, and systemic cidofovir treatment, she died because of progressive disease. HHV-8 associated malignancies are not prevalent in immunocompetent patients. Our patient, who has suffered from all three malignancies related to HHV-8, is the only HIV negative patient in the literature with primary effusion lymphoma, extracavitary/solitary variant.

Hiperglisemi (Kan şekeri> 250 mg/dL), metabolik asidoz (pH < 7,3), ketozis diyabetik ketoasidozun tanı kriterleri olarak belirtilmektedir. Nadiren kan şekeri 250 mg/dL altında diyabetik ketoasidoz görülebilmektedir. Bu durum öglisemik diyabetik ketoasidoz olarak adlandırılmaktadır. Nadir bir durum olmasına rağmen normal bir glukoz düzeyi tanıdan uzaklaştırabileceği için tedavinin gecikmesine ve bunun sonucunda artmış morbidite ve mortaliteye sebep olabilir. Sodyum-glukoz ko-transporter 2 (SGLT-2) inhibitörleri, diyabetes mellitus tedavisinde kullanılan yeni kuşak oral antidiyabetik ilaçlardır. Öglisemik diyabetik ketoasidoz gibi, nadir fakat ciddi advers etkileri vardır. Bu olgu sunumunda, nadir görülen bir durum olan empagliflozin kullanımına bağlı gelişen öglisemik diyabetik ketoasidoz olgusunun sunulması amaçlanmıştır., Hyperglycemia (Blood glucose> 250 mg / dL), metabolic acidosis (pH

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.

Giriş ve Amaç: Bu çalışmada, yoğun bakım hastalarının tedavi sürecinde ağrı düzeylerinin kontrolünde uygulanan standart sedo-analjezinin, bir enflamasyon belirteci olan serum prokalsitonini ile ilişkisinin saptanması amaçlanmıştır.Gereç ve Yöntemler: Araştırma, retrospektif olarak yoğun bakım kayıtlarından toplanan bilginin analizi ile gerçekleştirildi. Sedo-analjezi protokolü uygulanmadan önce hastaların ağrı tedavileri, hekim ve hemşirelerin düzensiz aralıklarla hastaları sübjektif değerlendirmeleri sonucuna göre, gereği halinde yapılmakta idi (1. Grup). Protokol ile güvenilir ölçeklerle, düzenli aralıklarla değerlendirilen ağrı ve sedasyon gereksinimleri, önceden kararlaştırılan ilaçlar ve dozlarla tedavi edilmeye başlandı (2. Grup). Hastaların prokalsitonin düzeyleri 5 gün süreyle sabah 1 kez ölçüldü. Bulgular: Parasetamol 2. grupta daha fazla kullanılmakla birlikte her iki grup arasında anlamlı fark saptanmadı. Tramadol 2. grupta istatistiksel olarak anlamlı oranda fazla kullanıldı. Fentanil dozu iki grup arasında anlamlı farklılık göstermedi. Sedasyon amaçlı kullanılan midazolam ise 2. grupta istatistiksel olarak anlamlı oranda daha az kullanıldı. Her iki grupta da prokalsitonin değerlerinin giderek azalma gösterme eğiliminde olduğu saptandı. 1. gün ile 5. gün arasındaki fark karşılaştırıldığında iki grup arasında istatistiksel olarak anlamlı farklılık saptanmadı (p= 0,56). Beş gün boyunca izlenen serum prokalsitonin median değerlerinin her iki grupta da benzer olduğu bulundu.Sonuç: Protokolize sedo-analjezi uygulaması yaptığımız olgularda prokalsitonin düzeylerinde bir farklılık saptamadık. Prokalsitoninin enfeksiyonda olduğu gibi ağrı takibinde de uygun bir belirteç olup olamayacağını anlamak için daha iyi standardize edilmiş hasta gruplarında ve daha geniş olgu serilerinde yeni araştırmalara gereksinim olduğu görüşündeyiz., Objective: In this study, it was aimed to determine the relationship between sedo-analgesia of intensive care patients and serum procalcitonin levels.Materials and Methods: The research was carried out retrospectively by analyzing the information from intensive care records. Before applying the sedo-analgesia protocol, the pain treatments of the patients were performed as required, according to the subjective evaluation of the patients at irregular intervals by the physicians and nurses (Group 1). With the protocol, pain and sedation needs, which were evaluated at regular intervals with reliable scales, were started to be treated with pre-determined drugs and doses (Group 2). Procalcitonin levels of the patients were measured once in the morning for 5 days.Results: Although paracetamol was used more in group 2, there was no significant difference between the two groups. Tramadol was used statistically significantly more in group 2. Fentanyl dose did not differ significantly between the two groups. On the other hand, midazolam was used statistically significantly less in group 2. Procalcitonin levels tended to decrease gradually in both groups. When the difference between the 1st day and the 5th day was compared, no statistically significant difference was found between the two groups (p = 0.56). Serum procalsitonin median values monitored for five days were found to be similar in both groups.Conclusion: We did not find any difference in procalcitonin levels in patients who underwent protocolized sedo-analgesia. In order to understand whether procalcitonin can be a suitable marker for pain follow-up as in infection, we think that new studies are needed in better standardized patient groups and larger case series.

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.

Diagnostic tests of COVID-19 are an important part of the epidemic and patient management. Diagnostic molecular, serological and biochemical markers also give important information for the treatment and follow-up of the disease. As time passed, the importance of these data laboratory were better understood and it started to be used more widely in clinical practice. It is clear that severe COVID-19 disease is associated with a potent inflammatory response leading to multi-organ failure. Clinical laboratory plays a critical role in the evaluation of inflammatory markers as well as the close monitoring of potential organ failure indicators in intensive care units. With this article, laboratory data that guide the diagnosis and treatment of COVID-19 disease are tried to be considered as a whole., COVID-19 tanı testleri salgının ve hasta yönetiminin önemli bir parçasıdır. Tanı koydurucu moleküler, serolojik ve biyokimyasal markerlar aynı zamanda hastalığın tedavisi ve seyrinin izleminde önemli bilgiler vermektedir. Zaman geçtikçe laboratuvar verilerin incelenmesiyle bu verilerin önemi daha iyi anlaşılmış ve klinik pratikte daha yaygın kullanılmaya başlanmıştır. Şiddetli COVID-19 hastalığı, çoklu organ yetmezliğine yol açan güçlü bir inflamatuar yanıt ile ilişkili olduğu açıktır. Klinik laboratuvar inflamatuar belirteçlerin değerlendirmesi yanında yoğun bakım ünitelerinde potansiyel organ yetmezliği göstergelerinin yakından izlenmesinde kritik rol oynar. Bu makale ile COVID-19 hastalığı tanı ve tedavisinde yol gösterici olan laboratuar verileri bir bütün olarak ele alınmaya çalışılmıştır.

Amaç: Bu çalışmada, akut ilaç intoksikasyonu nedeniyle YBÜ’de takip edilen hastaların demografik ve klinik özelliklerini retrospektif olarak incelemeyi amaçladık.Materyal ve Metod: YBÜ’ne akut ilaç intoksikasyon tanısıyla kabul edilen hastaların demografik özellikleri ve intoksikasyonların klinik karakteristik özellikleri kaydedildi. Bulgular: Çalışmaya 100’ü (%55,2) erkek, 81’i (%44,8) kadın olmak üzere toplam 181 hasta dahil edilmiş olup, hastaların yaş ortalaması 29,58±16,11 (min=14, max=88)’dır. İntoksikasyonların 154’ünün (%84,1) tıbbi ilaçlara bağlı olduğu ve 137’sinin (%75,7) intihar amaçlı olduğu saptandı. İntoksikasyona neden olan maddelerin %68,5’inin toksik dozda ve en sık antidepresan (n=38,%21.0), analjezik (n=27,%14.9), antiepileptik ilaçlar (n=16,%8.8) olduğu belirlendi. Hastaların 86’sında (%47,5) en az bir psikiyatrik hastalık ve 51’inde (%28,2) sistemik hastalık mevcuttu. İntoksikasyonların en sık ilkbahar (%33,1) ve en az yaz (%16,6) mevsiminde gerçekleştiği, 114’ünün (%63,0) taburcu edildiği ve 4’ünün (%2,2) hayatını kaybettiği saptandı.Sonuç: Akut ilaç intoksikasyonlarının büyük oranda psikiyatrik hastalık eşlik eden hastalarda, kendi kullandığı tıbbi ilaçlar ile intihar amaçlı meydana geldiği görüldü. Bu nedenlerle YBÜ’ne kabul edilen ilaç intoksikasyon olgularında psikiyatrik hastalık varlığının önemli olduğu sonucuna varıldı.

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.