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Objective: Organophosphates are commonly used in agriculture and mostly lead to intoxication. In this study, we examined the sociodemographic features, clinical findings, and the relationship between time to treatment with pralidoxime and mortality in patients with organophosphate poisoning treated in our clinic. Methods: We retrospectively examined hospital records of 179 patients who were managed for organophosphate poisoning in our clinic, between January 2001 and November 2009. Sociodemographic data, clinical findings, laboratory results, complications during follow-up, and outcomes were recorded. The patients were grouped as died and survived, and comparison of sociodemographic and clinical features, laboratory results, and treatment outcomes were performed. Results: Among 179 patients, 133 (74.3%) were female, 46 (25.6%) were male and mean age was 27.1+11.7 years. Fifteen (8.3%) patients died. Illiteracy rate among those who died was 66.6%, while it was 30.4% in those who survived. Among those who died, 13 (86.6%) had nicotinic and 14 (93.3%) had CNS signs. Assessment of cases by the time to PAM administration revealed mortality rates of 4.47% (n=6), 19.4 % (n=7), and 22.2% (n=2) for the first 3 hours (n= 134), 3-6 hours (n=36), and after 6 hours (n=9), respectively. Conclusion: A great majority of patients presenting with organophosphate poisoning were of low educational status, which was linked with mortality, indicates the importance of education. In addition, mortality rate was lower in patients who were administered PAM at an earlier period in the treatment process, suggesting the role of early PAM administration in reducing mortality. [ABSTRACT FROM AUTHOR]

Amniotic fluid embolism is a rare but a leading cause of maternal and fetal mortality. Etiopathogenesis is still unknown; it is an obstetric emergency with high mortality rates at birth or shortly after birth, characterized by the sudden onset of hypotension, hypoxia and severe coagulopathy. In this article a 35 year old woman whose preterm pregnancy resulted in maternal and fetal death was presented. We aimed to present a case of amniotic fluid embolism whose rare causes are associated with wide cranial and pulmonery embolism for differential diagnosis during pregnancy. (Yoğun Bakım Derg 2013; 4: 32-6) [ABSTRACT FROM AUTHOR]

The common variable immunodeficiency disease (CVID) is the most common symptomatic primary antibody deficiency. It is the most frequently observed cause of panhypogammaglobulinemia in adults. Here, we present a case of systemic amyloidosis that developed secondary to the common variable immunodeficiency disease causing recurrent infections in a young female patient. A 24-year-old female patient, who was under treatment at the gynecology and obstetrics clinic for pelvic inflammatory disease, was referred to our clinic when she was observed to have swellings in her legs, hands, and face. She had proteinuria at a rate of 3.5 gr/day, and her serum albumin was 1.5 gr/dl. The levels of immunoglobulins are IgG: 138 mg/dl, IgA: 22,6mg/dl, and IgM: 16,8mg/dl. The renal USG revealed that the kidneys were observed to be enlarged. Since the patient had recurrent infections, hypogammaglobulinemia, nephrotic range proteinuria, and enlarged kidneys in the renal USG, she was thought to have type AA amyloidosis and therefore underwent a renal biopsy. The kidney biopsy revealed amyloid (+). So the patient was diagnosed with AA type of amyloidosis secondary to common variable immunodeficiency disease. A treatment regimen (an ACE inhibitor and a statin) with monthly administration of intravenous immunoglobulin was started. [ABSTRACT FROM AUTHOR]

Introduction: Cases of intoxication is an important part of the patients admitted to General Internal Medicine Intensive Care Unit. The aim of this study is to present the features of patients admitted to our General Internal Medicine Intensive Care Unit with acute drug intoxication and clinical outcomes. Material and method: The data of patients with acute drug intoxication admitted to our General Internal Medicine Intensive Care Unit between June 2010 and December 2012 were analysed retrospectively. The patients’ age, gender, etiology, comorbid conditions, blood pressure, arterial blood gases, hematological and biochemical parameters, treatments and clinical outcomes were evaluated. Results: 81.4% of patients were female, 18.6% were male. The mean age of the patient was 30.23 ± 15.44 years. Multi-drug poisoning (51.2%)was the most common cause among the drug poisoning. 32.5% of the patients had comorbid conditions. The most common comorbid was psychosis among the disease. Only one patient hospitalized with organophosphate intoxication was need for mechanical ventilation due to extremely secretion. Hemodialysis therapy was performed 2 times in one patient with valproic acid intoxication. Conclusion: The cases of multi-drug intoxications (51.2%) were found to be more in patients with acute drug intoxication hospitalized into the General Internal Medicine Intensive Care unit. 16.2% of our patients hospitalized with drug intoxication had psychosis. [ABSTRACT FROM AUTHOR]

Amaç: Ventrikuler taşikardi, sıklıkla akut myokard enfarktusu, dilate kardiyomyopati gibi yapısal kalp hastalıklarına eşlik eden uc veya daha fazla ardışık 3 prematur vurunun olması olarak tanımlanır. Bununla beraber hipomagnezemi durumunda spontan olarak da meydana gelebilir. Bu bildiriyi sunmamızdaki amac Non-hodgkin lenfoma tanılı bir hastada gelişen ventrikuler taşikardinin nadir ve olumcul olabilen bir nedenini paylaşmaktır. [ABSTRACT FROM AUTHOR]

Amaç: Hemofagositik sendrom yoğun bakım hastalarında nadir gorulen ve mortalitesi cok yuksek olan bir hastalıktır.Hemofagositik sendrom spesifik olmayan semptomlarla karakterize olabileceği gibi şiddetli klinik tablo ile de karşımıza cıkabilir. Bu bildiriyi sunmamızdaki amac spesifik olmayan semptomlarla ortaya cıkan bir hemofagositik sendrom olgusunu paylaşmaktır. [ABSTRACT FROM AUTHOR]

Giriş: Yoğunbakım hastalarında solunum yetmezliği ve mortalitesi yük-sek olan akut respiratuar distress sendromu (ARDS) gelişebilmektedir.Bu bildiride amacımız ARDS ile takip edilen hastalarda recruitmentmanevrasının önemini vurgulamaktır. [ABSTRACT FROM AUTHOR]

Introduction: This study aims to research the effects of hematological and inflammatory parameters on the prognosis of COVID-19 disease and hospitalization duration. Methodology: One hundred and eighty-six patients with COVID-19 and a control group consisting of 187 healthy individuals were included in the study. Hematological variables and inflammatory parameters of the patients were recorded on the first and the fifth days of hospitalization. Results: White blood cell count, lymphocyte count, and platelet count were statistically lower, and mean platelet volume (MPV), neutrophil to lymphocyte ratio (NLR), and platelet to lymphocyte ratio (PLR) levels were higher in the patient group compared to the control group. It was observed that the neutrophil count and MPV level were lower, and the platelet count and ferritin level were statistically higher on the fifth day of follow-up compared to the admission day. In contrast, there was a significantly positive correlation between the duration of hospitalization and the fifth day D-dimer (r = 0.546, p < 0.001) and ferritin (r = 0.568, p < 0.001); in addition, there was a negative correlation between the duration of hospitalization and admission day lymphocyte count and the fifth-day lymphocyte count. Conclusions: Increased levels of ferritin and D-dimer, and decreased count of lymphocytes are among the important factors affecting the duration of hospitalization for COVID-19 patients. Furthermore, we think that neutrophil count and MPV levels are low, and platelet count and ferritin levels are high during the disease. Therefore, these parameters can be used as prognostic indicators of the disease. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the effect of nonsurgical periodontal therapy on serum C-reactive protein (CRP), interlökin-6 (IL-6) levels and periodontal parameters in patients with poorly and well controlled type 2 diabetes with chronic periodontitis. Methods: Forty-five patients were included in the study. Of the 45, 30 had type 2 diabetes mellitus with chronic periodontitis (group 1A; poorly controlled group, n = 15, HbA1c ≥ 7% and group 1B; well controlled group, n = 15, HbA1c < 7%) and 15 were systemically healthy (group 2) with chronic periodontitis. Plaque index, gingival index, probing depth, clinical attachment loss, gingival bleeding index scores, serum CRP and IL-6 concentrations were measured at baseline and 3 months after the nonsurgical periodontal therapy. Results: After the nonsurgical periodontal therapy all periodontal parameters and CRP and IL- 6 levels decreased significantly by the third month compared to baseline values in all groups. No statistically significant difference was determined among the groups between baseline and third-month periodontal parameters, or in CRP or IL-6 levels after nonsurgical periodontal therapy. Conclusion: Improvement in periodontal health is effective on control of systemic infection via reducing serum concentrations of CRP and IL-6 in patients with poorly and well controlled type 2 diabetes with chronic periodontitis. The effects of nonsurgical periodontal treatment seems to be independent of the degree of diabetic status. [ABSTRACT FROM AUTHOR]

Background: A good glycemic regulation should be provided to reduce mortality and morbidity in patients with end-stage renal failure due to diabetes mellitus. However, the use of insulin therapies in patients with renal failure is troublesome due to the increased rate of side effects. In our study, we investigated the frequency of hypoglycemia and its symptoms in patient groups receiving intensive and mixed insulin therapies. Materials and methods: This prospective study included 89 hemodialysis patients with DM-related stage 5 chronic kidney disease who were followed up in a nephrology clinic of a university hospital between January 2013 and August 2015. Our study group was divided into two groups as those receiving intensive insulin therapy and mixed insulin therapy. Group 1 and group 2 consisted of 46 patients and 43 patients, respectively. Hypoglycemia (glucose < 70 mg/dl) was investigated in patients with HbA1c levels that decreased below 7% after treatment, and the symptoms were evaluated according to the hypoglycemic scale. The results between the groups were evaluated using chi-square and Student's t test Results: A total of 89 patients were included in the study. HbA1c was 6.83% in the group receiving intensive insulin therapy and 6.95% in the group receiving mixed insulin therapy (p > 0.05). Hypoglycemia was detected in 27 patients (58.7%) in the intensive insulin therapy group and 14 patients (32.6%) in the mixed insulin therapy group. There was a significant level of hypoglycemia in the group receiving intensive insulin therapy (p < 0.05). In our study, the group receiving intensive insulin therapy had higher frequency and severity of common hypoglycemia symptoms such as confusion, sweating, weakness, dysphasia, palpitations, blurred vision, and feeling hungry. Conclusion: There was a higher frequency of hypoglycemia under intensive insulin therapy in patients undergoing dialysis due to chronic kidney failure, which suggests that mixed insulin therapy is the ideal treatment to avoid hypoglycemia in this group of patients. [ABSTRACT FROM AUTHOR]

Objective: Acute kidney injury (AKI) is an important clinical entity that is known to increase mortality in patients with sepsis. Erythrocyte maturation and proliferation are inhibited by pro-inflammatory cytokines; these cytokines exert effects on red cell distribution width (RDW) well. Based on this knowledge; our aim in this study was to evaluate the impact of RDW on acute kidney injury in patients with sepsis. Methods: 120 patients diagnosed with sepsis and admitted to intesive care unit (ICU) and treated between 2009-2013 were retrospectively evaluated. Patients were divided into two groups as follows: group 1 (RDW≥16.8) and group 2 (RDW<16.8). Multiple logistic regression analysis was used to determine the association between RDW and AKI and mortality. Results: There was a statistically significant relationship between AKI and RDW (p<0.001, OR=11.52) but there were no statistically significant relationship between AKI and sex, age, serum lactate levels as well as SOFA score. Also, there were statistically significant relationship between mortality and RDW (p=0.044, OR=5), serum lactate levels (p=0.030) and SOFA score (p<0.001). RDW was found associated with both AKI and mortality. Conclusions: Results suggest that RDW is an important parameter for predicting development of AKI and mortality in ICU patients with sepsis. [ABSTRACT FROM AUTHOR]

Objectives: The early diagnosis of volume overload in chronic kidney disease (CKD) is very important. N-terminal probrain natriuretic peptide (NT-proBNP) is a valuable biomarker for this purpose. Our study aimed to detect the relationship between NT-proBNP and left ventricular hypertrophy (LVH), hypertension (HT), GFR, and proteinuria among diabetic patients with stage 3-4 CKD. Methods: 160 diabetic patients with stage 3-4 CKD [80 patients in stage 3 CKD (group 1) and 80 patients in stage 4 CKD (group 2)] were enrolled. NT-proBNP levels were evaluated in serum, and proteinuria was determined from 24-hour collected urine. Left ventricular hypertrophy was evaluated by M-mode echocardiography. NT-proBNP levels were compared according to their left ventricular hypertrophy, hypertension, and proteinuria levels. Results: NT-proBNP levels was significantly higher, and GFR was lower in group 2 compared to group1 (p < 0.05). NTproBNP was higher in patients with LVH (+) HT (+) and proteinuria = 1gr/d than patients with LVH (-), HT (-), and proteinuria < 1g/d (p < 0.05). We found a significant correlation between NT-proBNP levels and left ventricular posterior wall thickness, diastole (LVPWTd), proteinuria, SBP, and DBP. Proteinuria was the major contributor to increased NTproBNP levels among the independent variables. Conclusion: We detected that NT-proBNP levels are increased during the progression of CKD, and proteinuria is the major cause of increased NT-proBNP levels among the independent variables. [ABSTRACT FROM AUTHOR]

Objectives: The early diagnosis of volume overload in chronic kidney disease (CKD) is very important. N-terminal probrain natriuretic peptide (NT-proBNP) is a valuable biomarker for this purpose. Our study aimed to detect the relationship between NT-proBNP and left ventricular hypertrophy (LVH), hypertension (HT), GFR, and proteinuria among diabetic patients with stage 3-4 CKD. Methods: 160 diabetic patients with stage 3-4 CKD [80 patients in stage 3 CKD (group 1) and 80 patients in stage 4 CKD (group 2)] were enrolled. NT-proBNP levels were evaluated in serum, and proteinuria was determined from 24-hour collected urine. Left ventricular hypertrophy was evaluated by M-mode echocardiography. NT-proBNP levels were compared according to their left ventricular hypertrophy, hypertension, and proteinuria levels. Results: NT-proBNP levels was significantly higher, and GFR was lower in group 2 compared to group1 (p < 0.05). NTproBNP was higher in patients with LVH (+) HT (+) and proteinuria = 1gr/d than patients with LVH (-), HT (-), and proteinuria < 1g/d (p < 0.05). We found a significant correlation between NT-proBNP levels and left ventricular posterior wall thickness, diastole (LVPWTd), proteinuria, SBP, and DBP. Proteinuria was the major contributor to increased NTproBNP levels among the independent variables. Conclusion: We detected that NT-proBNP levels are increased during the progression of CKD, and proteinuria is the major cause of increased NT-proBNP levels among the independent variables. [ABSTRACT FROM AUTHOR]

Non-steroidal anti-inflammatory drugs (NSAIDs) are often used in the treatment of chronic and acute pain and inflammation as an analgesic and anti-inflammatory agent. They inhibit the synthesis of prostaglandins which have influence on glomerular capillaries, vasa recta and tubular functions. They lead to significant complications such as hyperkalemia, hyponatremia, edema and hypertension. Usage of NSAIDs is a risk factor for acute kidney injury in some conditions such as advanced age, dehydration, vomiting, diuretics, ACE/ARB therapy, heart failure, nephrotic syndrome, cirrhosis and chronic kidney disease. Acute interstitial nephritis is not dependent on the drug dose and it is characterized by immunological inflammatory reaction and a decrease in creatinine clearance. Besides the classical findings, glomerules can be involved and minimal change disease or membranous glomerulonephritis can develop. Analgesic nephropathy is characterized by interstitial nephritis and papillary necrosis. Metabolites of NSAIDs are accumulated in renal medulla which has lowest oxygen pressure in kidney and they disrupt the renal parencymal perfusion by vasoconstriction. Respectively, papillar necrosis, glomerular sclerosis, interstitial fibrosis and cortical atrophy can develop insidiously. [ABSTRACT FROM AUTHOR]

Objective: To assess the probable agents affecting middle ear pressure in intubated patients hospitalized in intensive care units with various diagnoses. Methods: Middle ear pressure of 38 patients hospitalized in intensive care units within our faculty hospital was measured using portable tympanograms and acoustic reflectometry. The mode of the device to which each patient was attached and patients' blood pressure, Glasgow Coma Score, and additional disease parameters other than admission diagnosis were recorded. All data collected were subjected to statistical analysis to determine whether or not they affected middle ear pressure. Results: Septal deviation, survey, and mode of automatic respiratory device emerged as factors affecting middle ear pressure (odds coefficient 4.796, 3.745, 2.557, respectively, with 95% CI). Although aged over 60, additional disease and nasogastric tube also compromised middle ear pressure; the levels involved were not statistically significant (p>0.05). Conclusion: Middle ear pressure in patients hospitalized in intensive care units may change, particularly after the seventh day. This may particularly involve septal deviation, survey, and mode of automatic respiratory device, and tympanograms and reflectometry may be added to the patient-monitoring protocol in terms of changes in middle ear pressure. [ABSTRACT FROM AUTHOR]

Purpose: Nosocomial infections develop after 48-72 hours of hospitalization. Gram negative bacilli are generally the causative agent. 25% of all nosocomial infections develop in the intensive care units. Therefore, patients in the intensive care units are at high risk. This study aimed to determine the prevalence of nosocomial infections and causative gram negative bacilli in the Intensive Care Unit (ICU). Materials and Methods: 269 patients who were hospitalized in internal medicine intensive care unit (IMICU) of Dicle University Faculty of Medicine between june 2010- December 2010 were included in this study. Culture samples were taken from all of the patients who develops fever ( ≥38.5 C) after the hospitalization to the IMICU. Culture of blood, urine, sputum, central venous catheters, open wounds and deep tracheal aspirate were taken. Source and the prevalence of infection and distribution of the isolated causative pathogens were determined in the patients with gram negative bacilli reproduction. Results: 158 of the patients were male ( 58.7%) and 111 of the patients were female ( 41.3%). The mean ages of men and female were 58.81±16.91 and 56.44±19.16 years, respectively (p= 0.286). culture samples were taken from blood (16%), urine ( 8.6%), central venous catheter tips ( 6.3%), deep tracheal aspirates (10%), sputum (2.2%) and wound stabs (2.2%). Nosocomial infections were detected in 109 patients ( 40.5%). Pneumonia, urinary tract infections and gastrointestinal system infections were the most frequent infections respectively. Microorganisms were isolated from one sample in 97 patients, while 12 patients had more than focus. The most commonly isolated organisms were E.Coli (13.8%) and Pseudomonas Aeruginosa (7.4%), followed by Acinetobacter Baumannii (6.3%) and Stenotrophomonas Maltophilia (3.3%). Conclusion: Nosocomial infections in intensive care units have proved to be a serious problem. Surveillance studies should be performed for the isolated causative pathogens and measures should be taken to prevent the development of the ICU infections. [ABSTRACT FROM AUTHOR]