Makale Arama

Aim: To compare patients applied with tracheotomy because of prolonged intubation before the COVID-19
pandemic and during the pandemic.
Patients and Methods: A retrospective examination was made of the records of 179 patients with a tracheotomy
opened following prolonged intubation in the Intensive Care Unit of Karaman Training and Research Hospital
between September 2018 and August 2021. The patients were separated into two groups as group 1 (n:80)
of patients with tracheotomy in the 18-month period before the COVID-19 pandemic (September 2018 –
February 2020) and group 2 (n:99) of patients with tracheotomy during the COVID-19 pandemic (March
2020-August 2021). The two groups were compared in respect of demographic characteristics, duration of
intubation, early and late complications associated with tracheotomy, and patient outcomes (exitus, discharge
to home, transfer to palliative and other wards).
Results: Group 1 comprised 45% females and 55% males and group 2 comprised 51% females and 49%
males, with no statistically significant difference determined between the groups in respect of gender. A
statistically significant difference was determined between the groups in respect of age and the duration
of intubation (p<0.05). Tracheotomy-related complications were not determined to be significantly different
between the groups (p>0.05).
Conclusion: The patients in this study with a tracheotomy opened during the COVID-19 pandemic were
observed to be younger than patients with tracheotomy applied before the pandemic. In addition, the duration
of intubation was determined to be longer during the pandemic t han in the pre-pandemic period.

Aim: In this pre-and post- study, we aimed to compare changes in urological consultations and emergencies
between before and after the pandemic at the same time period o f 2019 and 2020 as two groups.
Patients and Methods: Patient files were retrospectively screened and numbers of consultations, surgeries
and admissions were evaluated. The two groups compared in terms of triage color codes, and final decisions.
Patients’ demographic data such as age and gender, triage color code, consultation order clinic, type of visit
(regular vs control), and operational data (type of surgery, prophylaxis status, place of OR etc) were recorded.
Results: A total of 89,674 patients presented to the emergency department in the 50-day period in 2019 and
53,745 patients in the same period of time in 2020. The number of patients presenting to the emergency
department decreased by 40.07% within the same period compared to the previous year. The percentage of
patients with the green triage code was decreased in 2020 by 30% compared to 2019, while the percentage
of yellow triage code was increased in 2020 by 28.9% compared to 2019. There was a dramatic fall in urology
visits in 2020 by 85.91%.
Conclusion: The COVID-19 pandemic is still ongoing, and it seems likely to continue for some time, despite
all efforts including vaccination programs and novel drugs that will also become available in a short time. The
number of patients cosulted with urology outpatient clinic has decreased during the pandemic.

ABSTRACT

Aim: Sternal dehiscence is one of the most troublesome complications following cardiac surgery. Although it can be corrected by simple methods if detected earlier, treatment failure or delay in sternal dehiscence may result in mediastinitis, which is highly lethal.  In this study, we aimed to investigate alternative sternal closure systems, mainly sternal talon (STalon) and titanium sternal plates (SPlate). Patients and Methods: In between April 2015 and January 2018, patients with sternal dehiscence after any kind of open cardiac surgery were included in this study. These patients were retrospectively evaluated according to the their demographic data, risk factors for sternal dehiscence, type of operations, techniques used for fixation of the sternum, mainly focusing on the STalon and titanium SPlate fixation. Results: A total of 45 patients were taken into surgical correction because of sternal dehiscence.  Thirty-four (75.6%) of the patients male, whereas 11 (24.4%) were female. Mean time interval after the first operation to sternal dehiscence was 68.5 days (1-780 days). Mean body-mass-index (BMI) was 31.52 kg/m² (22.03-43.69 kg/m²). Before the sternal fixation, mean CRP value was 68.34, whereas it was 75.55 before discharge. Confounding risk factors were internal mammarian artery (IMA) harvesting for coronary artery disease, diabetes mellitus, bronchial asthma, chronic pulmonary artery disease and advanced age. Mean post-operative intensive care unit (ICU) length-of-stay (LOS) was 5.02 days (1-29 days), whereas hospital LOS was 17.18 days (2-74 days). Early mortality was observed in 3 patients (6.67%). The first choice of operation was simple closure and/or Robicsek closure. Apart from simple and Robicsek closure techniques, sternal talon and/or titanium plates were used in 24 patients (53.3%). DM was found to be related to extanded total hospital LOS, ICU LOS, and postoperative time to discharge. DM also increased the risk of both superficial and deep sternal infection rates (p<0.05).  Conclusion: Ideal sternal closure should stabilize the sternum, be cost-effective and provide shortest hospital LOS with minimal post-operative complications. In patients with intact intercostal spaces, sternal talon may eliminate serious complications, such as cardiac rupture mainly caused by dense adhesions. Sternal plates are mainly effective in fragmented fractures without stable intercostal spaces. All patients should be individualized according to type of lesions and sternal fractures.

Aim

The decision to start treatment in sarcoidosis is made based on clinical and radiological findings and changes in pulmonary function test findings during follow-up, and more useful tools are needed in treatment management. F-18 fluorodeoxyglucose (18F-FDG) positron required important tomography / computed tomography (PET/CT) contains important information about the extent of sarcoidosis. On the other hand, the neutrophil/lymphocyte ratio (NLR) opens as a good prognostic marker for tissue-related inflammation. This study evaluated the relationship between the 18F-FDG PET/CT findings of sarcoidosis and NLR and other clinical findings.

Material and methods

The data of the patient who was diagnosed with sarcoidosis after 18F-FDG PET/CT examination in our clinic were retrospectively reviewed. Patients' age, gender, NLR values, smoking status, extrathoracic involvement and symptoms, and 18F-FDG PET/CT findings were compared.

Results

This study consisted of 41 patients. There was a strong correlation between NLR and whole body total lesion glycolysis (TLG), and moderate correlation between  MAIA and NLR (r values: 0.852, 0.660, both of them p value: <0.001, respectively). There was a significant difference between the groups showing only thoracic involvement and additional extrathoracic involvement with MAIA, TLG and NLR values (p values,: 0.002, 0.001 and, 0.003, respectively). In the classification made according to the symptoms of the patients, there was no significant difference between the groups with SUVmax, MAIA, TLG and NLR values. Median values were found to be significantly higher in the elderly group (p values: 0.037 and 0.040, respectively). In the classification made according to gender; there was no significant difference in both PET/CT parameters and NLR values.

Conclusion

The close relationship between the NLR value, which is accepted as a prognostic indicator in sarcoidosis, and the 18F-FDG PET / CT findings which show the involvement of the disease in the whole body, may provide the clinician with significant benefits in treatment management.

A rare cause of acute abdomen; appendiceal neuroma. Case report

ABSTRACT

    Acute abdomen refers to nontraumatic pathologies of abdominal origin which are characterized by sudden-onset abdominal pain. In most cases the cause of pain is a pathological condition requiring urgent surgical intervention. Acute appendicitis is the most common indication for surgical intervention in patients presenting to emergency department with acute abdomen. Obstruction of appendiceal lumen has been widely accepted as the precipitating factor in the pathophysiology of acute appendicitis. It usually develops as a result of food or feces particles entering into and obstructing appendiceal lumen, leading to inflammation and swelling of regional lymph nodes. Luminal obstruction results in overproduction of bacteria, excessive mucus secretion, and increased intraluminal pressure. Some studies in recent years have suggested a neural component in the pathophysiology of this condition. Such cases may present with various diagnoses such as obliterated appendix, fibrous obliteration, appendiceal neuroma, and neurogenic appendicitis. In this paper we present a case operated with the initial diagnosis of appendicitis and histopathologically diagnosed with appendiceal neuroma, a rare cause of acute abdomen.

 Moyamoya disease is an entity, which is caused by obstruction or stenosis in the area between the internal carotid artery, and anterior and middle cerebral arteries, identified angiographically, and does not have an exactly known etiology. The most frequent symptoms of onset are hemorrhage in adults and ischemia in children. In this paper, we present a case of Moyamoya disease which was diagnosed with a 21 year old male patient who was admitted to our emergency department with headache, nausea vomiting and left hemiparasi complaints and whose radiological findings showed right basal ganglia hemorrhage.

\r\n Colloid cysts are rare benign tumors of the third ventricle and have a wide range of clinical representations from incidentomas to acute death.  The growth of these cysts is an uncommon event and may cause obstructive hydrocephalus that lead to sudden deterioration in the patient's condition and may cause life-threatening complications. The large colloid cyst of third ventricle caused sudden death of children due to clogging, diagnosed in vivo is a very rare case in literature. We are representing here a case which patient admitted to emergency room for sudden loss of consciousness. Even he had urgent ventriculostomy due to acute hydrocephalus development, brain death has occured because of 3rd ventricle colloid cyst.

Aim: Diabetes, which has turned into a pandemic in the twenty-first century, concerns all branches of medicine. This study aims to investigate the prevalence of diabetes unawareness by checking HbA1c in patients hospitalized in clinics other than internal medicine and evaluate the factors associated with them.

Patients and Methods: The study included 630 patients hospitalized outside internal medicine services at or over the age of 18 whose anthropometric measurements could be made. The sociodemographic properties and comorbidities of the patients were recorded. Their anthropometric measurements, fasting blood glucose and HbA1c measurements were made. Those without a known diabetes diagnosis but with an HbA1c value of ≥6.5% were grouped as diabetes unaware. The differences among known diabetes, diabetes unaware and no diabetes  groups  were examined.

Results: The study was conducted between 01.03.2017 and 31.12.2017. The mean age of the patients was 58.04±18.56, while 54.6% (n=344) were male. The number of the patients with known diabetes was 190 (30.2%), 396 (62.9%) did not have diabetes, and unknown diabetes was detected in 44 (7%). Among the 234 patients with diabetes, 18.8% (n:44) had diabetes unawareness. The rate of those under the age of 45 in the diabetes unaware group (11.4%) was higher than that in the known diabetes group (3.7%) (p<0.01). Again, the rate of the male sex was also higher among the same individuals (68% vs 47.9%, p:0.15). The rate of overweight in the diabetes unaware group (56.8%) was higher than those in the known diabetes (37.9%) and no diabetes (39.1%) groups (respectively, p:0.36, p<0.01). There was no significant difference among the three groups in terms of educational levels. The rate of comorbidity presence was higher in the known diabetics (89.5%) than the diabetes unaware group (75%) (p:0.01). All patients with diabetes were evaluated by logistic regression analysis. The male sex, age<45 years, being overweight and absence of a comorbidity were associated with diabetes unawareness.

Conclusion: Undiagnosed diabetes was detected in 7% of the patients. Among all diabetic patients, 18.8% had diabetes unawareness. Conducting diabetes screening with HbA1c in inpatients and paying special attention to those under 45, males, overweight patients and those without comorbidities may help detect unknown diabetes.

This study was retrospectively registered at the Protocol Registration and Results System (Clinicaltrials.gov PRS)  with the registration number NCT04694326.

Today health related quality of life with its ever increasing importance has become an inherent part of treatment and follow up in all departments of medicine including diagnosis and treatment. In neuro-intensive care unit, the severest patients with the most intensive diagnosis and treatment period are followed up. Neurologic disorders with neurointensive care requirement include so many parameters potentially affecting the quality of life in acute and severe stages besides in chronic term. Apart from the effects of these diseases on life quality, there are many other important parameters related to quality of life. It is possible to list chief parameters as malnutrition in intensive care unit, agitation, pain, disruption of skin integrity, musculoskeletal system involvement, cardiovascular and autonomous involvement, side effect of drugs and multidrug interactions. In this review, the relationship between nutrition and health related quality of life in neurointensive care unit will be reviewed.

\r\n Prognostic importance of thrombocyte indices in children with carbon monoxide poisoning

\r\n

\r\n Abstract

\r\n

\r\n Objective: Carbon monoxide (CO) poisoning is still being a major cause of morbidity and mortality all over the world. Although the role of platelet functions in CO poisoning is not clear, increased platelet activation and aggregation had been reported previously. Increased thrombotic tendency due to endothelial damage, increased platelet stickiness, and alterations in the fibrinolytic pathway occurs in CO poisoning. The aim of our study was to determine whether platelet indices provide clinical benefit or not in children with CO poisoning.

\r\n

\r\n Materials and Methods: We retrospectively reviwed the records of children with the diagnosis of CO poisoning who admitted to the pediatric emergency departments of Konya Beyhekim State Hospital and Necmettin Erbakan University Meram Medical Faculty. A total of 92 children with CO poisoning and 62 age- and gender-matched healthy controls were included in the study.

\r\n

\r\n Results: While mean platelet volume (MPV) and platelet distribution width (PDW) levels were significantly higher (9,34±0,55 vs 9,78±0,97fL, p=0.001 ; 11,46±2,64 vs 10,57±1,41, retrospectively, p=0.007), platelet count and plateletcrit (PCT) (324,05±82,07 vs 357,27±89,70 x10⁹ p=0.015 ; 0,31±0,06 vs 0,33±0,07, retrospectively, p=0.039) were significantly lower in patients with CO poisoning. MPV levels were also significantly higher in patients with a carboxy hemoglobin (COHb) level higher than 20, when compared with COHb levels between 10-20 (9,40±0,84 vs 10,08±1,22 fL, p=0.003).

\r\n

\r\n Conclusion: Our results showed that platelet indices MPV and PDW are markedly elevated in patients with CO poisoning while platelet count and PCT were decreased. MPV and PDW levels, which reflect the changes in platelet activation and function, may predict the development of especially thromboembolic complications in the course of CO poisoning.  MPV and PDW levels may be useful in prognostic estimation of CO poisoning.

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\r\n Keywords: carbon monoxide; children; platelet indices; poisoning

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STUDY AIM: In this study, it was aimed to identify the accurate and inaccurate conceptions among the society on COVID-19 disease, which is considered as a public health problem and has a high risk of transmission. 

METHODS: The research was performed online at https://docs.google.com/forms in May 2020. The questionnaire form was composed of 40 queries, which were on sociodemographic characteristics and COVID-19. Following the study, the answers obtained from the questionnaire were analyzed by inserting related data to the software of SPSS. 

RESULTS: Of 580 participants involved in the study, 363 (62.6%) were female. The median age of the participants was 34.0 (18.0-77.0). Of the individuals who completed the questionnaire, 342 (59.0%) were married and 438 (75.5%) were university graduated and / or postgraduated. Of the individuals included in the study, 497 (85.6%) stated that they watched television / news channels to be informed about COVID-19. Most of the questions related to COVID-19 were answered accurately by the participants. The percentage of the premise, which was answered most accurately, was 577 (99.5%), whereas the lowest percentage of the accurately answered premise was 137 (23.6%). It was found that there was a statistically significant difference among the genders in terms of the percentage of accurate responses to the conceptions (p<0.05).

CONCLUSION: It was determined that the vast majority of the participants utilized from at least one news resource on COVID-19. Participants typically have accurate knowledge about COVID-19. Educational programs can be planned to enhance the awareness of the society about the conceptions, which were answered mostly inaccurately.

Aim: The aim of this study was to determine pressure ulcer prevention knowledge and attitudes among nurses who cared for surgical patients that were exposed to pressure ulcer risk factors such as immobilization and nutritional problems.

Materials and Method: This descriptive study was carried out with 150 nurses who were working in the surgical clinics and surgical intensive care units of a medical faculty hospital in XXXX and who had at least one year’s professional experience. Necessary permissions were obtained from the ethics committee and the institution prior to the research. Data were collected with a patient information form, the Pressure Ulcer Prevention Knowledge Assessment Instrument (PUPKAI) and the Attitude towards Pressure ulcer Prevention instrument (APuP) between October 1, 2018 and February 1, 2019.  Data were analyzed with the independent-samples t-test, the Mann-Whitney U test, the Kruskal-Wallis test, the correlation analysis and the multiple regression analysis.

Results: The mean age of the nurses was 29.91±6.48 years, 65.3% were female and half of them had undergraduate degrees. According to the PUPKAI total mean score (<60%), the pressure ulcer prevention knowledge of the nurses was inadequate and only 24% had a knowledge score ≥60%. Regression analysis results showed that, nurses' professional experience duration, working style, number of patients per shift and the experiences of giving care to patients with pressure ulcers were found to have a significant effect on the PUPKAI total mean score (p<0.05). According to the APuP total mean score (≥75%), the nurses had positive attitudes towards pressure ulcer prevention. It was also determined that the descriptive characteristics of the nurses did not significantly affect the APuP total mean score (p>0.05). There was no significant relationship between the total mean scores of the PUPKAI and APuP (p>0.05).

Conclusion: This study revealed that the surgical nurses had positive attitudes towards pressure ulcer prevention but they had inadequate knowledge about it. These findings highlight the need for institutional arrangements to ensure that nurses have access to evidence-based knowledge about pressure ulcer prevention.

Aim: In this study, we aimed to discuss our experience and results of non-operating room anesthesia.

Materials and Methods: Anesthesia records of patients older than 18 years who underwent sedo-analgesia outside the operating room for diagnosis and treatment between May 2017 and December 2017 were retrospectively screened. The records were examined in terms of demographic data, applied procedure, duration of the procedure, sedation grade, medications used, developing minor and major complications, chronic obstructive pulmonary disease story and intensive care need. Relationships between complications with demographic data and categorical variables were analyzed.

Results: Totally 2562 patients underwent sedo-analgesia. 1428 (55.7%) of these cases were female and 1134 (44.3%) of them were male. The average age of patients was 53.08±16.55. 268 (10.5%) of the cases were ASA I, 1683 (65.7%) were ASA II, 598 (23.3%) were ASA III and 13 (0.5%) were ASA IV. 519 (20.3%) patients were minimally sedated, 1541 (60.1%) were moderate sedated and 502 (19.6%) deep sedated. The longest procedure time in endoscopic retrograde cholangiopancreatography was 28.7 ± 16.3 min, and the shortest procedure time in endoscopy was 10.3 ± 3.1 min. The most commonly performed procedure was colonoscopy with 31%. The most commonly used drug combination was midazolam + propofol + fentanyl applied to 1231 patients (48%). 148 (5.76%) patients had minor complication, and 10 (0.37%) patients had major complication. A total of 15 (0.58%) patients underwent intensive care after the procedure. Desaturation was statistically significantly higher in patients with ASA III and above, in procedures take longer than 15 minutes, in patients older than 65 years, and in the presence of chronic obstructive pulmonary disease. The intensive care need after the procedure was also significantly higher in these patient groups.

Conclusion: The incidence of non-operating room anesthesia is increasing steadily. The risks associated with these practices are similar to the anesthesia in the operating room. In order to increase patient safety and reduce complications, it is important to carry out a thorough evaluation before the procedure, to provide proper monitored anesthesia care in appropriate physical conditions, and to establish healthy communication between the teams.

Aim: Hypoxemia is a vital criterion used to determine prognosis in coronavirus disease (COVID-19)
cases. This study thus examined the effectiveness of capillary refill time (CRT) in defining hypoxiadependent
disease severity in COVID-19 patients.
Patients and Methods: This prospective study was conducted with COVID-19 patients and an agematched
healthy group. The optimum test ambiance was provided, and a stable smartphone platform
was used to record the measurements (in ms) to standardize our method. The captured videos were then
evaluated using a video processing program.
Results: In total, 39 patients with COVID-19 and 40 control groups participated in this study. The patients
were further divided into the moderate (n = 25) or severe group (n = 14) according to disease severity.
The mean oxygen saturation of both moderate/severe groups was above 94%. Per disease severity, the
CRT measurements were higher in the severe group than in the moderate group (p = 0.009). In patients
without lymphopenia (n = 18), CRT values were found to be increased in the severe group (p = 0.008).
The use of CRT in patients with Covid-19 was practicable (AUC: 0.91; 95% CI 0.848-0.978; P = 0.001).
Conclusions: Our results show that CRT prolongation can occur in patients with COVID-19. In patients
without lymphopenia and with normal O2 levels, detecting CRT prolongation may be a criterion for early
admission to ICU.

Abstract

INTRODUCTION

Acute mesenteric ischemia (AMI) is an acute abdominal disease which is age-related with possible bad prognosis; and while its morbidity and mortality rate is 10% in early diagnosis and treatment it may progress with 100% mortality when diagnosis and treatment are delayed.The aim of this study was to unearth the efficiency of neutrophil-to-lymphocyte ratio (NLR) which has recently been started to be utilized in the prediction of AMI prognosis and used as a prognostic factor in many diseases.

MATERIALS and METHODS:

The data of a total of 111 patients, who had undergone surgical procedures and diagnosed with mesenteric ischemia intraoperatively at Necmettin Erbakan University Meram Medical School’s General Surgery Clinic between 2005 and 2013 and whose diagnoses had later on been confirmed pathologically, were retrospectively evaluated within the scope of the study.

The demographic data of all patients (age, sex) were recorded. The hemogram results of the patients, analyzed with peripheral blood, were reviewed for preoperative evaluation. The surgical procedure performed, the part and length of the resected bowel based on pathology results, the duration of hospitalization, survey, presence of comorbidity, white blood cell count, creatinine values, and NLR of the patients were determined. The data were statistically analyzed.

RESULTS:

The patients who did not survive had a mean NLR of 24.77 ±10.38, while the same ratio was found to be 17.6±10.65 for survivors. The NLO value was found to be high in cases with mortality.

CONCLUSION:

AMI still proves to have high mortality in spite of the developments in imaging techniques and laboratory analyses. There is no specific laboratory analysis for early diagnosis. High preoperative NLR in patients suspected to have AMI may indicate bad prognosis.

Objective: Brain death is defined as the complete and irreversible loss of all brain functions including the brain stem. Three major findings used for the diagnosis of brain death are coma, absence of the brain stem reflexes and apnea. The diagnosis of brain death has become more important with the increasing number of patients waiting for transplantation. The objective of this study was to determine the efficacy of computed tomography angiography in confirming brain death.

Material & Methods: Clinical brain death was reported in total 21 patients hospitalized in critical care unit of our hospital between October 2015 and June 2018. One of these patients was excluded since he underwent magnetic resonance angiography. CTA findings of the remaining patients were retrospectively evaluated. Patients were aged between 25 and 75 years with a mean age of 45 ± 1 years. CTA evaluations were performed using a 64 detector device. 100 mL contrast agent was delivered with a double head automated pump at a rate of 3.5 – 4 cc/sec as 350-375 mg/mL. When the region of interest reached to 90-100 HU cut off value, the images were acquired at 15-20 sec intervals on the axial plan. CTA findings were interpreted using 10- point scale.

Results: Causes of death were reported as intracranial hemorrhage in eight patients, ischemic cerebrovascular events in four patients, hemorrhage after craniotomy in three patients, cardiac arrest in two patients, post-traumatic contusio cerebri in one patient, and metabolic reasons in two patients.

Contrast filling was “0” in the ACA, PCA, MCA distal, and ICA supraclinoid branches of all 20 patients. Suspected contrast filling was found in MCA proximal in eight patients and unilateral ACA proximal in two patients. Each loss of opacification in the intracranial brancges was scored as 1 point. Accordingly, all patients were scored as 10 points.

Conclusion: According to our results, CTA is an effective and sensitive method for the diagnosis of brain death which is obligated by regulations.

Aim: This study aimed to evaluate the incidence of hypermetabolic axillary lymph nodes due to COVID-19
vaccines and the factors affecting hypermetabolic axillary lymph nodes in F18-fluorodeoxyglucose (FDG)
positron emission tomography/computed tomography (PET/CT) in on cology patients.
Patients and Methods: Among the patients who underwent FDG PET/CT in our institution between
January 15, 2021, and June 15, 2021, those who received one or two doses of COVID-19 vaccine
(CoronaVac or Biontech) were included in the study. Presence and number of ipsilateral hypermetabolic
axillary lymph nodes, FDG uptake, and whether there was a difference between these data after the 1st
and 2nd vaccination were investigated.
Results: Unilateral hypermetabolic axillary lymph nodes was observed in 9.9% (18/182) of the patients
[9.6% (9/94) after 1st dose, 10.2% (9/88) after 2nd dose] vaccinated with CoronaVac; It was detected in
37.5% (9/24) of the patients [35% (7/20) after 1st dose, 50% (2/4) after 2nd dose] who vaccinated with
Biontech. A negative correlation was found between the presence of hypermetabolic axillary lymph nodes
and age in patients who vaccinated with CoronaV ac.
Conclusion: The frequency of hipermetabolik aksiller lenf nodu after CoronaVac was lower than that
observed after mRNA vaccines, a small group of patients in our study, and lower than reported in the
literature. However, the statistical difference could not be evaluated due to the insufficient number of
patients in the Biontech group. A brief history of vaccination is recommended before FDG PET/CT to
reduce false positives. The potential role of FDG PET/CT in comparing the efficacy of vaccines produced
with dif ferent biotechnologies should be searched in studies with large r patient populations.

Amaç: Bu çalışmada, kritik bakım hastalarında yoğun bakım ünitesi (YBÜ) yatışında ölçülen kan üre
azotu (BUN)/albümin oranının hastane içi mortaliteyi tahmin etme açısından prognostik değerinin
değerlendirilmesi amaçlandı.
Hastalar ve Yöntem: Bu retrospektif gözlemsel çalışma, bir üniversite hastanesinin acil servisinde (AS)
gerçekleştirildi. Altı ay (1 Temmuz 2019 - 31 Aralık 2019) boyunca acil AS-YBÜ’ye yatırılan hastalar
çalışmaya dahil edildi. BUN/albümin oranının hesaplanmasında YBÜ’ye kabul öncesi ölçülmüş olan BUN
ve albümin değerleri esas alındı. Çalışmanın birincil sonucu ha stane içi mortaliteydi.
Bulgular: Çalışmaya toplam 572 hasta dahil edildi. Dahil edilen hastaların ortanca yaşı 66 (54–77) yıldı
ve bunların 362'si (%63,3) erkekti. Genel hastane içi mortalite oranı 29.0% (166 hasta) idi. Vefat edenlerin
ortanca BUN seviyesi hayatta kalanlardan daha yüksekti (38,2 (21,4-59,7) ve 21,9 (14,9-36,9) mg/dL,
p<0,001). Vefat edenlerin ortanca albümin seviyesi hayatta kalanlardan daha düşüktü (2,9 (2,3-3,5) ve 3,7
(3,2-4,0) g/dL, p<0,001). Vefat edenlerin ortanca BUN/albümin oranı hayatta kalanlardan daha yüksekti
(13.33 (6.69–22.99) ve 6.21 (3.83–11.21), p<0.001). Eğri altında kalan alanların sıralaması albümin
(0,742), BUN/albümin oranı (0,720) ve BUN (0,678) idi. Hastane içi mortaliteyi tahmin etme açısından
hesaplanan kesim değerleri, albümin için 3,2 g/dL, BUN/albümin oranı için 10 ve BUN için 32 mg/dL idi.
Sonuç: Sonuç olarak, YBÜ’ye yatış sırasında saptanan hipoalbüminemi, kritik hastalarda hastane içi
mortalite ile ilişkilidir. Yüksek BUN ve BUN/albümin oranı da bu hastalarda hastane içi mortalitenin
öngörücüleridir; ancak BUN ve BUN/albümin oranı hipoalbüminemid en daha üstün değildir .

Aim: In this study, it was aimed to evaluate the diagnosis and survival relationships of serum biomarkers
in patients with HCC and HRS, as well as to determine their sui tability for routine use in practice.
Patients and Methods: This is an observational, retrospective cohort study; between years 2005 and
2020. Only cases diagnosed with cirrhosis were included as the control group and these patients did not
have a diagnosis of HCC or HRS. In addition to the control group, 3 different groups were defined; HCC
group, HRS group and HCC&HRS group. Those with malignant disease (non-HCC) were not included in
the control group. Using neutrophil, lymphocyte and platelet counts obtained from hemogram results,
neutrophil-lymphocyte ratio (NLR), neutrophil-platelet ratio (NPR), systemic immune inflammatory index
(SII) score and CRP to albumin ratio (CAR) were calculated for all patient groups.
Results: A total of 110 patients were included in the study; While 26 (23.6%) of the patients were female,
84 (76.4%) were male. There were 29 (26.4%) patients in the cirrhosis group, 27 (24.5%) in the HCC
group, 18 (16.4%) in the HRS group, and 36 (32.7%) in the HCC&HRS group. Regardless of the groups,
63 (57.3%) of the patients in the whole population were diagnosed with HCC, while 54 (49.1%) were
diagnosed with HRS; 36 (32.7%) patients with HRS were Type 1 and 18 (16.4%) were Type 2 patients. In
terms of survival, 68 (61.8%) of all patients died during the follow-up period (exitus); 27 patients (24.5%
of all patients) died within the first year. In comparisons of the HRS detection capabilities of serum
biomarkers with ROC analyses, the only biomarker whose AUC value was not detected above 0.7 is SII;
AUC for >624 threshold: 0.674 (0.578–0.760). Comparisons of serum biomarkers' ability to predict overall
survival independent of diagnostic groups with ROC analyzes found AUC>0.7 for all biomarkers; The
highest sensitivity (70.59%) and specificity (80.95%) values we re determined for NLR and CAR.
Conclusion: Serum biomarkers NLR, NPR, SII and CAR are sufficient to predict overall survival in the
presence of HCC, HRS in cirrhotic patients. NLR, NPR and CAR have sufficient sensitivity and specificity
to detect hepatorenal syndrome.

Aim: The aim of this study was to investigate the relationship between the seriousness of the clinical condition of the patients in intensive care unit (ICU) and acute stress symptoms of family members.

Patients and Methods: After local ethic committe approval and written informed consent was obtained, we carried out a prospective, descriptive study at a universty hospital in patients’ relatives. Clinical characteristics (APACHE II score) of patients was recorded. First degree relatives  of 60 ICU patients provided demographic data and completed the State-Trait Anxiety Inventory Form  (STAI) and Pittsburgh Sleep Quality Index (PSQI) within 24 h of ICU admission and 21 days later.

Results: There were a moderate correlation between APACHE 2 and STAI scores on  day 1 (r =0.477)  and a strong correlation (r = 0.503) on day 21 (p<0.05). A moderate correlation (r = 0.503)  was found between APACHE 2 score and PSQI on day 21. STAI scores were not different between genders on day 1. There was an increase in both sexes in STAI scores on day 21), and the scores ere significantly more in females (p=0.003). While there was no statistically significant difference in PSQI scores on day 1, an increase was found in both sexes on day 21 (p <0.001). Female family members  had more sleep disturbances  (p=0.008). STAI scores were higher in both mothers and fathers on day 1 and 21 (p<0.001).

Conclusions: An increasing relationship was determined between patients' acute physiological condition and anxiety with sleep quality level of patients’ relatives as the time passed.

Aim: Burns are common, especially in children. Here, we aimed to determine incidence of attention deficit
hyperactivity disorder (ADHD) symptoms in children with burns a nd compare them with healthy children.
Patients and Methods: This prospective study was conducted between August 2019 and April 2021. The
study group consisted of pediatric patients aged between 3-16 years admitted to the pediatric emergency
with burns. Children aged between 3-16 years admitted for non-traumatic reasons also constituted the
controls. Cultural and demographic characteristics of both groups were similar. After initial intervention
and stabilization, the revised Conners’ Parental Rating Scale (CPRS-R) was applied to both groups.
Results: The study group consisted of 143 individuals with a mean age of 6.93±2.96 years, and 69
(48.3%) were girls. The control group consisted of 140 children (mean age: 6.72±2.48 ranging between
3-16 years), and 49.3% were girls. There was no statistically significant difference between both groups
regarding age and gender (p=0.36, 0.84, respectively). The most common cause of burns (69.2%)
was exposure to hot water or oil spill. Most of the victims due to burns (89.5%) were discharged from
emergency after outpatient intervention. All subscale scores calculated through CPRS-R, except for
cognitive problems/inattention subscale scores, were significantly higher in the study group than the
controls. The educational status of the parents in the study group was hi gher than those of the controls.
Conclusion: Our findings indicated that the incidence of ADHD symptoms may be higher in children
admitted to the emergency department due to burn injuries.

Aim: The literature revealed that group of COVID-19 patients who experience anosmia and ageusia
symptoms is younger, is predominantly female, and experiences a milder course of the disease. This
study aimed to evaluate the relationship of the presence of anosmia and ageusia symptoms with the
severity of pneumonia and laboratory test results in hospitaliz ed patients with COVID-19.
Patients and Methods: A retrospective evaluation was made of patients who were hospitalized by
the Department of Pulmonology between October 2020-March 2021 and underwent thorax computed
tomography (CT). Thorax CT findings of the patients were scored with a severity score for each lobe and
a total score was obtained. Pneumonia was classified according to the shape, distribution and appearance
of the lesions, and laboratory test results were obtained. These findings were compared according to the
presence of anosmia and ageusia symptoms.
Results: Evaluation was made of a total of 177 patients, comprising 89(50.2%) males and 88(49.8%)
females with a mean age of 53.0±14.5 years (range, 18-89 years). The number of patients who experienced
at least one of the symptoms of anosmia and ageusia (Group 1) was 67(37.9%) and the rest (Group 2)
did not experience any of these symptoms. The Group 1 patients who experienced these symptoms was
younger (p=0.009). No difference was determined between groups regarding the total pneumonia score
and involvement patterns (p> 0.05). The groups were similar in terms of laboratory results(p> 0.05) .
Conclusion: The prevalence of anosmia and ageusia in hospitalized patients is not a small number and
is more common in the younger population. No association was seen between the presence of these
symptoms and milder pneumonia severity and laboratory results. These symptoms do not have prognostic
value for the severity of the disease in hospitalized patients.

Objective: To determine the effect of COVID-19 infection on anxiety level in pregnant women.

Material and Methods: In this study, a questionnaire and Beck anxiety scale were applied to pregnant women who referred to outpatient clinic for routine pregnancy control in June 2020 to determine their concerns that may be related to COVID-19. Pregnant women admitted with obstetric emergencies and obstetric risk were not included in the study.

Results: 177 pregnant women were included in the study and the pregnant women were divided into four groups according to their score on Beck anxiety scale. Anxiety level of pregnant women was 44.6%. The possibility of not being with his family at the time of birth and the fear of death due to COVID-19 were statistically significantly associated with higher anxiety levels.

Conclusions: In this process, it is important to provide psychosocial support in addition to the follow-up of pregnant women by a multidisciplinary team consisting of perinatology, newborn and intensive care specialists.

The purpose of this review is to systematically review the intervention studies conducted and published to
prevent central catheter-related bloodstream infections. In this study, MEDLINE, CINAHL COCHRANE Library
and PUBMED databases were searched using “Preventing CLABSI infections” (Central Line-associated
Bloodstream Infection = CLABSI) as a keyword. Studies published in international journals between January
1, 2016 and November 10, 2020 were evaluated, and 99 publications were reached as a result of the search.
Seven studies were included in the scope of the review in line with the inclusion / exclusion criteria. As a
result of the investigated studies, the application of evidence-based infection control measures such as
hand hygiene, adherence to maximum barrier precautions during catheter insertion, skin antisepsis with 2%
chlorhexidine, appropriate dressing, avoiding the femoral vein and questioning the need for daily catheters
through appropriate methods It has been found to be effective in preventing associated bloodstream infections.
As a result of this systematic review, it was determined that evidence-based infection control measures
should be continued to be applied in adult intensive care units, especially in adult intensive care units, in order
to reduce the incidence of central catheter-associated bloodstr eam infections.