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Purpose: In the present study, the possibility of predicting mortality with the change in coagulation parameters depending on the severity of Covid-19-associated pneumonia was investigated. Materials and Methods: A total of 137 patients with Covid-19-associated pneumonia were included in the study. The patients were divided into three groups according to the severity of pneumonia as mild, moderate and severe. According to the severity of pneumonia, the parameters of complete blood count and the levels of biochemical parameters were compared between the groups. By examining blood parameters according to mortality, ROC analysis and regression analysis were performed to determine the net effect of these parameters on mortality. Results: As the severity of pneumonia increased, Prothrombin time (PT), International normalized ratio (INR) and Activated partial thromboplastin time (aPTT) values were also increased, and a statistically significant difference was found between the groups in PT and INR values. PT, INR and aPTT levels were higher in cases with mortality. Mortality can be predicted with 93.5% sensitivity and 97.5% specificity. according to the >45.1 seconds(sec) cut-off value of the coagulation parameter (aPTT+PT. Conclusion: The coagulation parameter (aPTT + PT), whose level increases secondarily to the increase in Covid19-associated pneumonia severity, provides successful results in predicting mortality, and may be a parameter that we can recommend in clinical use. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

L'âge ne constitue pas en soi une contre-indication à la transplantation rénale. Les premières études réalisées sur le sujet avaient montré un bénéfice de la transplantation rénale pour la survie des sujets âgés éligibles à la transplantation par rapport au maintien sur liste d'attente. Cependant, des données plus récentes suggèrent que ce bénéfice n'est pas aussi constant, avec notamment une période de surmortalité précoce étendue après transplantation. L'éligibilité des sujets âgés à la transplantation doit reposer sur l'habituelle prise en compte des comorbidités, mais doit aussi comporter pour certains patients une évaluation gériatrique, pour dépister d'éventuels signes de fragilité. La décision de transplanter un sujet âgé doit aussi intégrer les caractéristiques des donneurs, l'utilisation de donneurs de plus en plus à la marge pouvant avoir un impact négatif sur la survie de ces patients. Age per se should not be a contraindication to kidney transplantation. The first studies have shown a benefit for the survival of elderly eligible patients getting a kidney transplant compared to be maintained on the waiting list. However, more recent data suggest that this benefit is not as constant, notably with a significant early mortality period. The eligibility of elderly patients for transplantation must be based on the usual consideration of co-morbidities, but should also include, for some patients, a geriatric evaluation to detect clinical symptoms of frailty. The decision to transplant an elderly recipient must also integrate the characteristics of the donors, since the use of donors with increasingly expanding criteria can have a negative impact on the survival of these patients. [ABSTRACT FROM AUTHOR]

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Copyright of MN Cardiology / MN Kardiyoloji is the property of Medical Network and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of MN Cardiology / MN Kardiyoloji is the property of Medical Network and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

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Copyright of Bagcilar Medical Bulletin / Bağcılar Tıp Bülteni is the property of Galenos Yayinevi Tic. LTD. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Journal of Tepecik Education & Research Hospital / İzmir Tepecik Eğitim ve Araştırma Hastanesi Dergisi is the property of Logos Medical Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Journal of Ankara University Faculty of Medicine / Ankara Üniversitesi Tip Fakültesi Mecmuasi is the property of Galenos Yayinevi Tic. LTD. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: This study was planned to evaluate effectiveness of cardiac surgery score (CASUS) system used for the prediction of mortality after the cardiac surgery and to compare it with EuroSCORE, a tested and approved method. Method: Fifty patients over the age of 18 who came to the intensive care unit (ICU) after open heart surgery and stayed in the ICU for more than 48 hours were prospectively included in the study. After the preoperative EuroSCORE evaluation of the patients, CASUS scoring systems were used for risk scoring from postoperative 0 day to the service or up to the 6th postoperative day (or possible mortality) in patients whose stay in ICU was prolonged. We evaluated the place of both models in the prediction of ICU mortality. Results: The study was conducted with 50 patients- 21 female, 29 male-, aged between 19 and 79 years (mean age: 60.38±12.50). Five (10%) cases exited.The areas under the ROC curve were estimated as follows: EuroSCORE, 45.3%; and for CASUS 0,1, and 2. day scores AUCs of ROC curve were 66,9%, 64,7%, and 79,8%, respectively. The CASUS 2nd day score was found to be valuable in predicting mortality (p<0.01). A statistically significant relationship was observed between the days of stay in the ICU and mortality. Conclusion: Our results show that the rate of the accurate prediction of mortality of CASUS is insufficient on postop 0th and 1st day; however CASUS score on postoperative 2nd day has sufficient.predictive accuracy EuroSCORE is not found effective in the prediction of mortality. It is observed that if the duration of stay in ICU is prolonged, it statistically significantly increases the risk of mortality. [ABSTRACT FROM AUTHOR]

Objective: In late 2019, the Coronavirus disease 2019 (COVID-19) has been pandemic worldwide, starting in Wuhan, China. In this study, we aimed to evaluate the factors associated with 28-day outcomes in patients admitted to the intensive care unit with the diagnosis of COVID-19. Method: This study has a retrospective cohort design. COVID-19 patients identified according to World Health Organization guidelines are included. Patient data were recorded to a centralized system utilizing ImdSoft-Meta vision/QlinICU Clinical Decision Support Software. Individual datasets about required parameters were obtained from Structured Query Language (SQL) queries. The main laboratory parameters were examined. SOFA, APACHE II, and Charlson Comorbidity Score (CCS) were calculated. In evaluating laboratory parameters and disease risk scores, which are thought to affect 28-day mortality, logistic analysis were performed using the Backward LR model. Results: The study was carried out with 101 patients, 40 (39.6%) of whom were women, and 61 (60.4%) of men, who met the inclusion criteria. The ages of the patients ranged from 21 to 88, and the mean age was 58.45 ± 15.41 years. The mean intensive care hospitalization period was 12.5 ± 10.2 days. The all-cause in-hospital mortality rate was 61.4%. Leukocyte count, CK, NT-proBNP, PCT, CRP, ferritin, neutrophil count and percentage, D-Dimer, LDH, AST values were found to be significantly higher in non-survivors. The lymphocyte count and percentage, and platelet count values were found to be significantly low in non-survivors. The lymphocyte percentage, LDH, and CCS were significant in the 28-day mortality in multivariate analysis (p values are 0.01, 0.003, 0.008, respectively). Conclusion: High lymphocyte values have been found to significantly reduce the risk of death in patients diagnosed with COVID-19. Lymphocyte percentage, LDH, and CCS were evaluated as the most successful parameters in predicting 28-day mortality in the intensive care unit. [ABSTRACT FROM AUTHOR]

Objective: In this study, we aimed to investigate the relationship between long-term mortality and survival in patients with ABO blood group, and acute coronary syndrome. Method: This observational study was carried out in two tertiary hospitals. A total of 192 patients followed up for 72 months due to acute coronary syndrome, and showing a balanced distribution for ejection fraction, additional diseases and age, were included in the study. Results: The survival rate was evaluated in 72 months of follow-up. In the survival analysis made according to individual blood groups; a statistically significant difference was not detected between groups. When the patients were divided into two groups, mortality rates were 24.39% in patients with, and 15.23% without blood group O (p>0.05). Although not statistically significant, in patients with blood group O, an increasing tendency was observed in 72 month-mortality rates (p>0.05). Any association between Rh antigen and survival was not found in this study (p=0.79). Conclusion: Although it could not reach the limit of statistical significance, a decreasing tendency in long-term survival was observed in acute coronary syndrome patients with blood group O compared to those without The results should be confirmed by larger prospective studies. [ABSTRACT FROM AUTHOR]

Background: The early neonatal mortality rate is a good indicator of the quality of care and the level of economic and social development of a population. The purpose of this work was to determine the prevalence, etiological profile, and risk factors of early neonatal mortality. Methods: It was a retrospective descriptive study conducted in the neonatal medicine and resuscitation department of the maternity and neonatal center of Tunis over a period of 9 months from January to September 2017. During this period 3,560 newborns were hospitalized in the neonatal resuscitation department. Among them 150 early neonatal deaths occurred. Results: The incidence of early neonatal mortality was 15 per 1000 live births. The very early neonatal mortality rate occurring during the first 24 hours of life was 15%. Sixty percent died after 48 hours of life. The rate of premature babies was 68%. The leading causes of early neonatal deaths were an infectious cause in 38.6% of cases with a maternal-fetal infection in 25% of cases and healthcare-associated infections in 14% of cases, congenital malformations in 18.7% of cases, and perinatal asphyxia in 12.7% of cases. The main risk factors for early neonatal mortality were unregulated pregnancies, socio-economic status, prematurity, low birth weight, perinatal asphyxia, cardiac malformations and central nervous system malformations. Conclusion: Early neonatal mortality is still high. To try to reduce it we insist on the monitoring of pregnancies, the prevention of prematurity and the improvement of the neonatal infrastructures. [ABSTRACT FROM AUTHOR]

Objective: Risk factors affecting mortality in the coronavirus disease-2019 (COVID-19) pandemic, which emerged in Wuhan, China and affected the whole world, are yet to be clearly determined. Assessment of Charlson comorbidity index (CCI) and pneumonia severity index (PSI) can assist clinicians in identifying patients at high risk of mortality. This study aimed to determine the relation between CCI, indicating comorbidity burden in COVID-19 infection, and PSI, indicating disease severity, and their relationship with mortality. Materials and Methods: This was a retrospective cohort study conducted by accessing demographic, clinical and laboratory data from the electronic medical records of 214 patients diagnosed with COVID-19. The patients were followed up in the intensive care unit of University of Health Sciences Turkey, İstanbul Bakırköy Dr. Sadi Konuk Training and Research Hospital between March 10, 2020 and June 1, 2020. Results: Patients were divided into two groups i.e., survivors (n=109; 50.9%) and those with mortality (n=105; 49.1%). A one point increase in CCI was determined to increase the mortality probability by 32% [odds ratio (OR): 1,324, 95% confidence interval (CI): 1,178-1,488]. On the other hand, a one-point increase in PSI increased the mortality possibility by 2% (OR: 1,020, 95% CI: 1,012-1,0,27). In the correlation analysis performed to determine the relationship between CCI and PSI, a bidirectional and strong correlation was found between CCI and PSI (p<0.001, r=0.667). Conclusion: As a model for summarizing the sum of age and comorbidities, CCI can help identify patients at high mortality risk in the COVID-19 pandemic. Moreover, PSI may be useful in patients with low CCI scores for predicting mortality in COVID-19 patients; however, has not been found reliable in patients with high CCI scores. [ABSTRACT FROM AUTHOR]

The aim of the study was to evaluate the application of different types of skin allograft as a skin substitute for coverage of major deep burn wounds, and their effect on the clinical outcomes and mortality of burned patients. This prospective study was conducted on 36 patients admitted to the Burn Unit from August 2016 to November 2019. The number and percentage of patients that needed auto-grafting after surgical intervention was 9 (100%) in Group I (allograft coverage not available), 13 (86.66%) in Group II (allograft source was from unrelated patients) and 8 (66.7%) in Group III (allograft from a first-degree relative). Patient survival was 55.6% in Group I, 86.7% in Group II and 91.7% in Group III. There was significant difference between the groups regarding time to complete healing, with P1 = 0.034* and P2 < 0.0001*. Human skin allograft harvested from living first-degree relatives is freshly donated at maximum viability and does not require complex preparation or preservation. It shows prolongation of graft survival that helps to improve general condition, decrease microbial wound contamination, improve vascularization and prepare the wound bed with healthy granulation tissue. This promotes wound healing and subsequent autograft take, and decreases mortality rate among burned patients. [ABSTRACT FROM AUTHOR]

It is known that patients suffering from neurological illnesses have an increased risk of burn injuries. These burns are often very severe and lead to poor outcomes. To date, only a few studies have evaluated the impact of pre-existing neurological illnesses on the outcome of burn injuries. None of them performed a regression analysis regarding specific influence on mortality. Between 1996 and 2016, 1475 patients were admitted to the BICU of a specialized German burn center: 26 had less than 1% TBSA burned and were excluded; 177 had pre-existing neurological disorders (group N). 87 patients with psychological disorders were excluded. 1185 patients without neurological or psychological disorders formed the control group. Length of hospital stay, TBSA and number of operations were analyzed using the chi-squared test and Mann-Whitney U-test. Additionally, mortality was evaluated using the logistic regression analysis adjusted for known outcome predictors. Mean age of the patients in the control group was 41.53 years with a BICU stay of 18 days, TBSA of 18.25% and mortality rate of 12.4%; 23.7% had inhalation injuries. Patients in group N had a mean age of 54.63 years, a BICU stay of 27 days, mean TBSA of 20.97%; 31.1% had inhalation injuries and mortality was 20.3%. Patients with neurological disorders were older and showed higher affected TBSA, higher rates of inhalation injury, mortality and affected TBSA, and a longer stay in the BICU compared to the control group. Nevertheless, pre-existing neurological disorders alone had no significant influence on mortality. [ABSTRACT FROM AUTHOR]

Nosocomial bacteremia (NB) is one of the most severe infections in burns in intensive care units. Their prognosis is worsened with the emergence and spread of multidrug resistant bacteria (MDR). Our retrospective study aimed to investigate clinical and bacteriological characteristics of NB occurring in patients hospitalized in the Trauma and Burn Center's Burn Unit (TBC-BU) in Tunisia, during a 3-year period (2016-2018). We found 261 NB in 216 patients, for a prevalence of 25.7% and an incidence density of 13.4‰ days of in-patient stay. The vast majority (88.9%) of NB occurred during the first 2 weeks of hospitalization. The catheterrelated bacteremia rate was 11.1%. P. æruginosa (20.2%) and A. baumannii (16.8%) were the 2 species most frequently isolated when S. aureus represented only 7.5% of isolates. Resistance rates were high, with 71% of P. æruginosa resistant to ceftazidime, 64% of S. aureus being MRSA, 69,5% of resistance to 3rd generation cephalosporins among Enterobacteriaceae, and colimycin remaining the only regularly active antibiotic (98%) on A. baumannii. The MDR rate was 44%, represented mainly by A. baumannii, ESBL-E and P. æruginosa. The mortality rate due to NB was 25%, with a significantly higher rate of MDR in fatal NB compared to that in NB with favorable outcome (p = 0,000019). [ABSTRACT FROM AUTHOR]

Copyright of Population & Sociétés is the property of Institut National d'Etudes Demographiques and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

French Guiana is an overseas territory of France with marked specificities in terms of populations, socioeconomic factors, risk factors, and an access to care. In this context, the objective of the present study was to describe the epidemiology of acute coronary syndromes in French Guiana and to make comparisons with mainland France and neighbouring country. The data were obtained from a retrospective descriptive hospital-based cohort conceived to describe the incidence of acute coronary syndromes and their epidemiologic and clinical characteristics. It included patients aged 18 or more hospitalised for a first coronary syndrome in the reference centre for coronary syndromes in Cayenne French Guiana between Jan 1st 2012 and Dec 31st 2014. Overall, 266 patients were analysed. The mean age was 64 years (SD = 12.54). A majority of patients were men (sex ratio = 1.83). The proportion of patients born in an overseas French territory (44.36%) was similar to that of those born in a foreign country (43.98%), and 11.65% were born in mainland France. Only 59% of patients had regular health insurance. Moreover, 33.21% had universal medical insurance (CMU for those below a minimal income), 4.91% had state insurance (for illegal foreign patients) and 2.64% had no insurance at all. The main risk factors were high blood pressure (73.68%), diabetes (39.85%), hypercholesterolemia (40.23%), and smoking (37.97%). Overall, 82/266 patients developed an ST elevation coronary syndrome (STEMI) and 184/266 had a non-ST elevation coronary syndrome NSTEMI or unstable angina pectoris. Thrombolysis was only performed in 20.73% of patients with STEMI. Mortality at 1 month was 8/82 (9.76%) for STEMI and 2/184 (1.09%) for NSTEMI. The epidemiologic profile of acute coronary syndromes in French Guiana is different from that of mainland France and Europe to the neighbouring country Brazil. Mortality of STEMI also seems higher than in mainland France, but similar to Brazil. In a context of frequent health inequalities, interventions targeting the major risk factors, notably high blood pressure, obesity and diabetes, have the potential to significantly impact cardiovascular morbidity and mortality. [ABSTRACT FROM AUTHOR]

Introduction: The aim of this study was to reveal the factors that affect the clinical outcomes of patients undergoing surgery in our university hospital for intestinal atresia (IA) and to share our experience. Methods: We analyzed data from 74 newborns with IA who underwent surgical treatment between January 1997 and December 2016. Results: The study population consisted of 40 female and 34 male newborns with a mean age at diagnosis of 6.4±8.3 days. The mean birth weight was 2.3±0.6 kg, the mean gestational age was 35.6±2.8 weeks, the mean maternal age was 28.9±6.1 years, and the mean hospitalization time was 24.5±25.3 days. Duodenal atresia was the most common diagnosis (n=31, 42%) and colonic atresia the least common (n=2, 3%). The longest and shortest mean hospital stays occurred in patients with jejunal (32.8±41.6 days) and those with colonic (8±0 days) atresia, respectively. Although the survival rates were low in newborns with either intestinal or duodenal atresia (80% or 81%, respectively), all patients with pyloric or colonic atresia survived. Of the patients who died, 82% (9/11) had additional congenital abnormalities (X2 =8.461, p=0.004), which included major cardiac defects (n=3), Down syndrome (n=2), biliary atresia (n=1), esophageal atresia + tracheoesophageal fistula + anal atresia + tracheal atresia (n=1), esophageal atresia + tracheoesophageal fistula (n=1), and microcephaly (n=1). The mean hospital stay of patients with or without additional abnormalities was 26.4±21.4 or 23.04±28.04 days, respectively (p=0.207). Conclusion: Among newborns with IA, duodenal atresia was the most common diagnosis and colonic atresia the least common. Additional congenital abnormalities negatively affect the hospital stay and mortality rate of newborns with IA. [ABSTRACT FROM AUTHOR]

Objective: We aim to evaluate the demographic and clinical characteristics of patients with acute carbon monoxide (CO) poisoning, who had a Glasgow Coma Score (GCS) below 15, and who had cerebral lesions detected in magnetic resonance imaging (MRI). Methods: The age, gender, causes of CO intoxication, clinical signs, neurological findings, GCS, blood carboxyhemoglobin level (COHb), serum pH, lactate, creatine kinase (CK), creatinine kinase-myocardial band MB (CK-MB), troponin-I level, brain MRI (T1- weighted, T2-weighted, FLAIR and diffusion-weighted imaging), treatment, and mortality status of 327 patients were evaluated retrospectively. Results: The median age of patients was 31.5 years (IQR=19.5 years), 72.2% of the patients were women. Neurological findings were detected in 34 (10.4%) of the patients. The frequency of dyspnea was significantly higher in patients with neurological findings (p<0.05). The COHb and lactate levels of patients with neurological findings were found to be significantly high, the pH level was significantly lower (p<0.05). There was no significant relationship between the presence of neurological findings and CK, CK-MB, and troponin-I levels (p>0.05). Patients with neurological findings were found to have a significantly longer follow-up period, more frequently received hyperbaric oxygen therapy (p<0.05). The rate of hospitalization was 10.7%, the mortality rate was 0.9%. Hospitalization and mortality rates were significantly high in patients with neurological findings (p <0.05). Pathological findings were detected in 13 (40.6%) of 32 of patients (except for 2 patients who did not respond to the resuscitation) who had an MRI. Conclusions: It was determined that acute CO poisoning may lead to acute brain damage, 40.6% would be detected in brain MRIs taken in patients during the acute phase. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to evaluate the demographic characteristics, emergency care needs and prognosis of patients aged 65 years and older who presented to our Emergency Medicine Clinic with abdominal pain for a period of one year. Patients and Methods: In this single-center, retrospective, observational study included patients aged 65 years and older who presented to the emergency department with abdominal pain between June 15, 2015 and June 14, 2016. The related variables were recorded from the patients' electronic and written files. The general patient population and the differences of variables in the 65-74 age group, 75-84 age group and >85 age group were investigated. Results: A total of 1330 patients were included in the study. The mean age of the patients was 75.2 ± 7.2 years and 582 (43.8%) were male. While 58.8% of the patients were discharged from the emergency department, the most common hospitalization wards were General Surgery (14.1%) and Gastroenterology (11.4%). The ICU admission rate increased with age (p<0.001; 3.3% - 5.8% - 11.6%). The mean length of stay in hospital was 5.9 ± 7.1 days and the in-hospital mortality rate was 3.4%. While 50.1% of the patients in the 65-74 age group were discharged from the emergency department without consultation, this rate decreased to 36.6% in the ≥85 age group and the difference was statistically significant (p<0.001). Abdominal ultrasound was performed in 34.1%, abdominal tomography in 20.0% and both of them in 7.5% of the patients. Conclusion: The patients aged 85 years and older with abdominal pain are more likely to be characterized by more examination needs, more consultation needs, more hospitalization rates and higher mortality rates. Taking these differences into consideration during the management of the elderly patients with abdominal pain in emergency department will help to reduce morbidity and mortality rates while improving patient care quality. [ABSTRACT FROM AUTHOR]

Objective: Liver transplantation is still up to date as the only and definitive treatment for patients with end-stage liver failure. We examined the mortality and morbidity results of 28 patients who underwent liver transplantation in our clinic. Method: Data of 28 patients who underwent liver transplantation in our clinic between January 2018 and December 2019 were retrospectively analyzed and included in the study. Results: The mean age of patients who underwent orthotopic liver transplantation (OLT) was 51.7±12.7 years (20-73 years). Of the 28 patients, 21 were male (75%) and 7 were female (25%). The mean ejection fraction (EF) was 56.9±3.4%. The mean model end-stage liver disease (MELD) score was 22.3±5.3. After one year follow-up, 8 of 28 patients died (28.6%). Two or more units of erythrocyte suspension (ES) were given to 5 of 8 patients who died (p=0.044). Two patients received one or more units of fresh frozen plasma (FFP) (p=0.011). It was observed that administration of ES and FFP to patients increased mortality. The mean operation time of the patients who died was 12.7±0.9 hours. It was found that prolonged operation time increased mortality (p=0.027). Five patients who died were operated for the second time due to surgical complications. It was found that second operation of patients increased mortality (p=0.023). It was observed that harvesting the grafts from a living donor or cadaver had no effect on mortality (p=0.801). Conclusion: It was found that giving blood and blood products to patients who underwent liver transplantations, performing a second operation and prolonging the operation time increased mortality. [ABSTRACT FROM AUTHOR]

Objective: The defective interplay between coagulation and inflammation may be the leading cause of intravascular coagulation and organ dysfunction in coronavirus disease-19 (COVID-19) patients. Abnormal coagulation profiles were reported to be associated with poor outcomes. In this study, we assessed the prognostic values of antithrombin (AT) activity levels and the impact of fresh frozen plasma (FFP) treatment on outcome. Materials and Methods: Conventional coagulation parameters as well as AT activity levels and outcomes of 104 consecutive critically ill acute respiratory distress syndrome (ARDS) patients with laboratory-confirmed COVID-19 disease were retrospectively analyzed. Patients with AT activity below 75% were treated with FFP. Maximum AT activity levels achieved in those patients were recorded. Results: AT activity levels at admission were significantly lower in nonsurvivors than survivors (73% vs. 81%). The cutoff level for admission AT activity was 79% and 58% was the lowest AT for survival. The outcome in those patients who had AT activity levels above 75% after FFP treatment was better than that of the nonresponding group. As well as AT, admission values of D-dimer, C-reactive protein, and procalcitonin were coagulation and inflammatory parameters among the mortality risk factors. Conclusion: AT activity could be used as a prognostic marker for survival and organ failure in COVID-19-associated ARDS patients. AT supplementation therapy with FFP in patients with COVID-19-induced hypercoagulopathy may improve thrombosis prophylaxis and thus have an impact on survival. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to determine the factors affecting the clinical characteristics and mortality of the patients followed up in the Pediatric Intensive Care Unit due to heart disease. Material and Methods: The patients diagnosed with acquired and congenital heart disease between January 2009-September 2011 in Pediatric Intensive Care Unit were examined. The diagnosis, clinical features and the factors affecting to the mortality were investigated. Results: In this study, the data of 65 cardiac patients who were hospitalized were evaluated. The most of the patients were acyanotic, like as ventricular septal defect (VSD), and these were generally followed up with the diagnosis of infective endocarditis (IE). In addition, the most of them had congestive heart failure (CHF), pulmonary hypertension (PHT) and growth retardation. Patients diagnosed with atrioventricular septal defect (AVSD) consisted of cases with Down syndrome hospitalized due to pneumonia, acute congestive heart failure (CHF) and pulmonary hypertension crisis. The cyanotic patient group consisted of single ventricular structures such as Fallot tetralogy (TOF), Great artery transposition, tricuspid valve atresia (TA), hypoplastic left heart syndrome, and extensive (single ventricul) ventricular septal defect. The most of the myocarditis cases have been due to viral myocarditis. Fourteen cases with cardiomyopathy (CMP) were examined and 2 cases with Naxos disease and 1 case with non-compaction died. Five cases with supraventricular tachycardia (SVT) and 2 with Long QTc syndrome were observed due to arrhythmia. Apart from heart disease, 20% of patients had additional diseases, especially Down syndrome. Conclusion: Atrioventricular septal defect (AVSD), the severity of DCMP, aplication of the mechanical ventilation, using of the inotropic agents were found to be risk factors for mortality in patients followed up in the intensive care unit. [ABSTRACT FROM AUTHOR]

In the absence of interventional endoscopy the treatment of upper digestive hemorrhage a the brazzaville university hospital is only medicinal. Objective of this work was to identify risk factors for upper gastrointestinal bleeding by conducting a retrospective case-type study conducted over a period of 2 years. The 180 patients included for upper digestive hemorrhage were divided into 2 groups accordind to their progressive modality: deceaded patients (cases) and non-deceased patients (controls). Risk factors for mortality were studied by logistic regression. The mortality linked to upper gastrointestinal bleedind was 36.6%, the risk factors for death were age between 30 and 60 with an OR of 9.79; male (OR of 2.03); late hospitalization over 24 hours (OR of 6.30); blood transfusions (OR of 3.5). The protective factors were hemoglobin greater 7 g/dL (OR of 0.28); treatment by proton pump inhibitors (OR of 0.36). In conclusion, reducing the still high mortalty rate in our country requires taking into account the identified risque factors and aquiring endoscopic hemostasis equipement. [ABSTRACT FROM AUTHOR]

Objective: Pertussis is a serious public health problem and a major cause of vaccine-preventable deaths under 5 years of age. The aim of this study is to present the clinical data of the patients who were hospitalized with the diagnosis of pertussis/pertussis-like disease. Material and Methods: Hospitalized 1-4 months old infants diagnosed with pertussis/ pertussis-like disease from January 2018 to September 2018 at l were assessed retrospectively. Results: A total of 97 patients (51 males, 46 females) were diagnosed with pertussis/pertussis-like disease. Median age of the patients was 2 months (min-max 0.97-3.90). There was spasmodic cough in all cases. Thirty-two (33%) cases had abnormal lung auscultation sounds (rales and/or rhonchi), 5 cases had apnea and 36 cases had tachypnea. Nasopharyngeal smears for pertussis were taken from 31 patients (32%). Twelve from 31 nasopharyngeal smears (39%) were positive for B. pertussis using polymerase chain reaction (PCR). There was no significant difference between pertussis PCR positive group, pertussis PCR negative group and unexamined group in terms of hospital stay and age of patients. Total leucocyte and lymphocyte count in pertussis PCR positive group were significantly higher than in other two groups. Two patients were referred to the intensive care unit due to respiratory distress after their first day of hospitalization. Both received mechanical ventilator support and were discharged with cure. Conclusion: Pertussis infection causes significant morbidity and mortality in early infancy. Appropriate strategies should be developed to protect these babies. [ABSTRACT FROM AUTHOR]

Background: Stroke account for 15% of all deaths in Turkey. In acute ischemic stroke (AIS), neuronal damage continues every minute until the occluded vessel is not opened. Currently, the most important treatment of AIS is the rapid and effective opening of the occluded vessel. In this study, we aimed to share our experience of endovascular treatment of AIS patients in our center. Materials and Methods: Between January 2015 - November 2018, the first 100 consecutive patients who presented with the diagnosis of AIS and received endovascular treatment were included in this study. We recorded the clinical and demographic characteristics and endovascular procedure characteristics of all patients. Results: Of the 100 patients included in the study, 49 were female and 51 were male, and the median age was 65 (55-74). Hypertension was present in 74%, hyperlipidemia in 25%, diabetes mellitus in 38%, atrial fibrillation in 26%, coronary artery disease in 36%, and smoking in 39% patients. The Median NIHSS score was 15.5 (13-19) prior to treatment. At the 3-month follow-up, 31 patients died and the mortality rate was calculated as 31%. At the end of the 3-month, good outcome was observed in 40% of patients (modified Rankin scale score 0-2). Our effective recanalization rate (Thrombolysis in Cerebral Infarction [TICI2b-3]) was found to be 75%. Conclusions: AIS patients with suspected large artery occlusion should be transferred to centers where endovascular treatment is available, as soon as possible. Better results can be achieved as experience of endovascular treatment in centers increases. [ABSTRACT FROM AUTHOR]

La recherche épidémiologique peut fournir une clef d'interprétation de l'incongruence de genre (IG) (Gender Incongruence [GI]) et d'identification des besoins médicaux des sujets avec une incongruence de genre. L'IG faisant l'objet de différentes définitions, il est difficile d'estimer sa véritable prévalence. Les données sur la prévalence de l'IG sont influencées par la définition nosographique et par les différentes méthodologies mises en œuvre par les chercheurs pour évaluer les nombres de cas. Selon les estimations existantes, la prévalence, qui présente de larges variations, se situe entre 0,1 % et 1,1 % chez les adultes, avec un ratio homme vers femme (ratio male-to-female [MtF]), femme vers homme (female-to-male [FtM]) de 1-6. Chez les enfants, la littérature rapporte une prévalence entre 1 % et 4,7 %, avec une prédominance du ratio MtF chez les enfants, et de 1,2 % à 16,1 % chez les adolescents pour lesquels le ratio FtM semble prédominant. Les études basées sur l'accès aux cliniques transgenres sont susceptibles de sous-estimer la prévalence de l'IG alors que les études qui mettent l'accent sur les données auto-déclarées ou déclarées par les parents pourraient surestimer le phénomène. La littérature décrit des taux élevés de troubles affectifs et d'anxiété (18–80 %), de fréquents troubles de la personnalité (20–70 %), des tentatives de suicide et des blessures auto-infligées chez les personnes vivant avec une incongruence de genre. Ces problèmes semblent s'améliorer après un traitement d'affirmation de genre. Certains auteurs font état d'une forte prévalence de troubles du spectre autistique (TSA) (Autistic Spectrum Disorders [ASD]) (6–14 %) chez les jeunes avec une incongruence de genre. Les taux de mortalité, les infections VIH et les maladies sexuellement transmissibles sont élevés chez les transgenres, probablement en raison d'un manque de prévention. Il est essentiel de déterminer la véritable prévalence de l'IG afin d'assurer un soutien médical adéquat. Les futures études devraient être basées soit sur de grandes cohortes multicentriques soit sur la population générale, faisant appel à des échantillonnages fondés sur les répondants et comprenant également des sujets qui n'ont pas recours aux services proposés par les cliniques transgenres, afin de minimiser les biais de sélection. Epidemiological research may offer a key to interpreting gender incongruence (GI) and identifying the medical needs of people with GI. Currently, it is difficult to estimate the real prevalence of GI due to the use of different definitions. The data on GI prevalence are influenced by case definition and by the different methodologies applied by researchers to assess cases. Estimations of prevalence therefore vary widely and are estimated between 0.1% and 1.1% among adults, with a male-to-female (MtF) – female-to-male (FtM) sex ratio of 1–6. For children, the literature reports a prevalence ranging from 1% to 4.7%, with a predominance of MtF for children and from 1.2% to 16.1% in adolescents, among whom FtM appears to be predominant. Studies based on access to gender clinics may underestimate GI prevalence while studies focused on self- or parent-reported data may overestimate the phenomenon. The literature describes high rates of affective and anxiety disorders (18–80%) and frequent personality disorders (20–70%), suicide attempts, suicide and self-harm among people with GI. These problems seem to improve after gender affirmation treatment. Some authors report a high prevalence of Autistic Spectrum Disorders (ASD) (6–14%) among youth with GI. Mortality rates, HIV infection and sexually transmitted diseases are high among the transgender population, probably related to lack of prevention. It is crucial to determine the true prevalence of GI in order to deliver adequate medical support. Future studies should be based on large multicenter cohorts or population-based surveys, and should adopt respondent-driven sampling while including individuals who do not seek services offered at gender clinics, to limit the selection bias. [ABSTRACT FROM AUTHOR]

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Introduction: The "Programme d'Accompagnement du retour à Domicile" (PRADO) COPD is a home discharge support program dedicated to organizing care pathways following hospitalization for COPD exacerbation. This study aimed at assessing its medico-economic impact., Methods: This was a retrospective database study of patients included in the PRADO BPCO between 2017 and 2019. Data were extracted from the National Health Data System. A control group was built using propensity score matching. Morbi-mortality and costs (national health insurance perspective) were measured during the year following hospitalization., Results: While the proportion of patients with a care pathway complying with recommendations from the National Health Authority was higher in the PRADO group, there was no significant effect on mortality and 12-month rehospitalization. In the PRADO group, the rehospitalization rate was lower when the care pathway was optimal. Healthcare costs per patient were 670 € higher in the PRADO group., Conclusions: The PRADO COPD improves quality of care but without decreasing rehospitalizations and mortality, although rehospitalizations did decrease among PRADO group patients benefiting from an optimal care pathway., (Copyright © 2024 SPLF. Published by Elsevier Masson SAS. All rights reserved.)

Objectif : déterminer les facteurs associés aux décès chez les patients atteints de tétanos, hospitalisés au service des Maladies Infectieuses du CHU du Point-G. Matériels et méthode : il s'agit d'une étude rétro-prospective chez les malades atteints de tétanos, hospitalisés dans le service de Maladies Infectieuses du CHU du Point G de janvier 2013 à avril 2015. Les dossiers de tous les cas de tétanos âgés de 18 ans et plus répondant aux critères d'inclusion ont été inclus. Les données ont été saisies sur Word et analysées sous le logiciel SPSS. Le test X² a été utilisé pour la comparaison des variables qualitatives avec un seuil de significativité p≤0,05. Résultats : trente-cinq cas de tétanos ont été colligés sur 972 hospitalisations soit une prévalence de 3,6%. La totalité des patients était des hommes. Aucun patient n'avait un calendrier vaccinal à jour. La majorité des portes d'entrée tégumentaires était causée par des accidents de la voie publique (soit 31,7%). Les cultivateurs étaient les plus exposés avec 37,1%. Les comorbidités (15 cas) étaient le paludisme, l'hypertension artérielle et le diabète avec respectivement 53,3% ; 33,3% ; et 13,3%. La létalité du tétanos était de 25,7%. Les facteurs associés de façon significative à la mortalité était l'hypertension artérielle, les complications pulmonaires et les fausses routes. Conclusion : Cette étude montre que les comorbidités et les complications ont majoré la létalité du tétanos. La prise en charge rapide et correcte des complications et des comorbidités pourra avoir un impact positif sur le pronostic des patients atteints de tétanos.

L’objectif de l’étude a été de caractériser les performances reproductives (fertilité, prolificité, mortalités) et pondérales des lapines de la souche synthétique algérienne « ITELV 2006 », conduites en insémination artificielle (IA) avec un rythme semi-intensif (intervalle mise bas – IA de 12 jours). Durant deux années consécutives (2017 et 2018), un suivi de la conduite de reproduction de 73 lapines, faisant l’objet de 327 IA, a été mené à l’animalerie de l’Université de Chlef (Algérie). Durant la durée de l’étude, les IA ont été réalisées à partir d’une semence récoltée chez des mâles du même type génétique et analysée localement. Les données relatives à l’IA, à la palpation, à la mise bas et au sevrage ont été enregistrées pour l’ensemble des femelles. L’effet de la saison sur les critères de poids et les performances de reproduction des lapins a été analysé. Toutes les données ont été soumises à une analyse de variance. Les femelles ont montré une bonne prolificité de 9,5 ± 2,4 nés totaux dont 8,4 ± 2,9 nés vivants par mise bas et 7,4 ± 2,6 sevrés par sevrage, avec des taux de fertilité de 85,6 ± 35,1 % à la palpation et 69,7 ± 45,9 % à la mise bas. Le poids adulte des femelles à l’IA était de 3584 ± 391 g. Le lapereau pesait en moyenne 63 ± 13 g à la naissance et 490 ± 81 g au sevrage. Un effet très significatif de la saison a été enregistré sur la fertilité et la prolificité des lapines, et sur le poids et la mortinatalité des lapereaux avec les plus faibles valeurs enregistrées en saison chaude (63 % de fertilité). Cependant, les femelles sont restées productives durant cette période de grande chaleur.

La section traumatique du cholédoque est un phénomène extrêmement rare surtout lorsqu´elle est isolée. Habituellement, elle survient suite à une chirurgie des voies biliaires notamment laparoscopique. Cette lésion est souvent associée à une ou plusieurs lésions des organes de voisinage. Nous rapportons un cas de section isolée du cholédoque suite à un traumatisme abdominal chez un enfant âgé de 5 ans pris en charge dans notre service au Centre Hospitalier Mère et Enfant de Nouakchott. L´exploration radiologique n´était concluante. Une laparotomie exploratrice faite devant un tableau chirurgical a révélé une péritonite généralisée d´origine biliaire secondaire à une plaie du bas cholédoque. Le traitement d´urgence était une toilette avec une dérivation biliaire externe suivie à un mois après par une dérivation bilio-digestive. La complication la plus redoutable de section de cholédoque est la péritonite biliaire. La morbidité postopératoire précoce est de l´ordre de 20 à 30% dans la littérature alors que la mortalité est de 0 à 2%. La section traumatique isolée du cholédoque chez l´enfant est une lésion dont le tableau clinique et la conduite thérapeutique doivent être connus afin de diminuer la morbi-mortalité. La prise charge doit être multidisciplinaire impliquant le chirurgien pédiatre, le radiologue et le réanimateur anesthésiste.

INTRODUCTION: l´accident vasculaire cérébral (AVC) constitue un problème majeur de santé publique, tant par le nombre de personnes atteintes, que par ses conséquences médicales, sociales et économiques. L´objectif était de dégager les facteurs de mauvais pronostic vital à la phase aiguë de l´AVC artériel. METHODES: il s´agit d´une étude prospective durant quatre mois portant sur les patients présentant une symptomatologie évocatrice d´AVC aux deux CHU de Sfax, Tunisie. Le suivi a été de un mois. RESULTATS: nous avons colligé 200 patients. Après un mois de suivi, la mortalité était de 19,9%. Les facteurs de mauvais pronostic vital étaient: le sexe masculin, la consommation de tabac, l´antécédent d´AVC, le score de Glasgow bas, le NIHSS élevé, les céphalées, les crises épileptiques symptomatiques aiguës, le signe de Babinski, la mydriase, l´aphasie, la déviation conjuguée de la tête et des yeux, les chiffres élevés de pression artérielle systolique (PAS), pression artérielle diastolique (PAD) et pression artérielle pulmonaire (PAP), l´hyperthermie, l´hyperglycémie, l´hyperleucocytose, l´augmentation des CRP, créatinine, urée et la troponine Tc, la nature hémorragique de l´AVC, l´œdème péri lésionnel, l´effet de masse, l´engagement, la topographie sylvienne totale de l´ischémie, la présence de signes précoces d´ischémie, l´hémorragie méningée, l´inondation ventriculaire, l´hydrocéphalie, le recours à une assistance respiratoire, au traitement anti-œdémateux et antihypertenseur, la transformation hémorragique, l´épilepsie vasculaire, les complications infectieuses, métaboliques et de décubitus. CONCLUSION: l´identification des facteurs prédictifs du devenir vital permet d´optimiser les procédures thérapeutiques et mieux organiser les filières de prise en charge. Une étude comparative sera envisagée afin de mesurer l´impact des mesures correctives.

Amaç: Bu çalışmanın amacı koroner arter bypass greftleme (CABG) operasyonu geçiren hastalarda mortalite açısından uygun skorlama sistemini bulmak amacı ile EuroSCORE II, Lojistik EuroSCORE ve SYNTAX skorlarının karşılaştırılmasıdır.Gereç ve Yöntem: Kliniğimizde CABG cerrahisi geçiren 228 hastanın demografik özellikleri, ekokardiyografik bulguları, operasyon notları ve dosyaları, perfüzyon ve gözlem notları değerlendirildi. Bulgular: Mortaliteyi belirlemek amacıyla SYNTAX skorunun prediktif değeri 27.5’ten (>27.5) büyüktü, lojistik regresyon (LR+) değeri ise 1.5 idi. EuroSCORE II’nin prediktif değeri 1.82’den yüksekti (>1.82) ve LR+ değeri 2.20 idi. EuroSCORE II’nin pozitif prediktif değerinin düşük olmasına rağmen bir yıllık mortalite oranını tahmin etmede yeterli olduğu bulundu. Mortalite oranını değerlendirmede Lojistik EuroSCORE’un prediktif değeri 5.71’den büyüktü (>5.71) ve LR+ değeri 5.13 idi. Lojistik EuroSCORE da bir yillik mortalite oranini tahmin etmede yeterliydi.Sonuç: Çalışmamızda bir yıllık mortaliteyi tahmin etmede Lojistik EuroSCORE en etkin skorlama sistemi olarak bulunmuştur. İdeal kardiyak risk skorlama sistemini bulmak için randomize klinik çalışmalara ihtiyaç olduğu kanısındayız.

Amaç: Bu çalışmanın amacı başvuru ve 48. saatte alınan prokalsitonin seviyesinin mortalite ve yatış süresi üzerine etkisinin araştırılmasıdır. Gereç ve Yöntem: Kesitsel retrospektif olan çalışmamızda 3 ay içerisinde acil servise başvuran ve pankreatit tanısı ile servise yatırılan hastalar çalışmaya alındı. Çalışmaya dahil edilen tüm hastaların yaş, cinsiyet, kronik hastalık varlığı, alkol alımı, taş varlığı, ranson geliş değeri, ranson 48. saat değeri, bilgisayarlı tomografi şiddet indeksi, lökosit, platelet, lenfosit, nötrofil sayıları, nötrofil lenfosit oranları, platelet lenfosit oranları, C-Reaktif Protein, Prokalsitonin 0.saat, Prokalsitonin 48.saat düzeyleri ve bunların 6 aylık mortalite ve morbidite üzerine etkisi değerlendirildi. Bulgular: Çalışmaya alınan 39 hastanın %48.7 si (n=19)’u erkek %51.3’ü (n=20) kadındı. Pankreatit tanısı alan hastalardan %10.3 hastada (n=4) alkol kullanımı, %53.8 hastada(n=21) taş varlığı tesbit edildi. Olguların yatış süreleri ile C-Reaktif Protein değerleri arasında pozitif yönde ve istatistiksel olarak anlamlı korelasyon bulundu. 6 aylık mortalite (+) olguların Ranson 48. Saat değerleri 6 aylık mortalite (-) olguların Ranson 48. saat değerlerinden istatistiksel olarak anlamlı yüksek bulundu. Prokalsitonin başvuru esnasında, Prokalsitonin 48.saat düzeyleri ve bunların 6 aylık mortalite ve yatış süreleri üzerine istatistiksel anlamlı etkisi bulunmadı. Sonuç: Pankreatit tanılı hastalarda acil serviste C-Reaktif Protein değerlerine bakılması yatış süresinin tahmininde kullanılabilir. Prokalsitonin başvuru esnasında ve 48. saat değerleri acil serviste yatış süresi ve mortalitenin değerlendirilmesinde kullanımı uygun değildir. Ranson 48. Saat değerlendirmesi mortalite tahmininde kullanılabilir.

Aim: To determine the frequency of malnutrition in patients with benign and malignant disease admitted to the general surgery service, evaluate the methods used in recognition of malnutrition and to investigate the role of malnutrition in the development of postoperative complications.Patients and Method: Between February 2004 and May 2005, in 723 patients, who were operated in General Surgery Department, frequency of malnutrition was detected five different methods (Nutrition Risk Index, Subjective Global Assessment, rate of weight loss, serum albumin level, Body Mass Index). Medically treated patients were excluded. Patients were followed for nutritional support, complication and mortality.Results: In 723 patients, total malnutrition rate was detected 30.5% and severe malnutrition rate was 8.9%. Patients with benign diseases, had a malnutrition rate of 25.8% despite patients with malign diseases, had a rate of 53.3%. We got highest frequencies r to determinate total and mild malnutrition with Nutritional Risk Index. For severe malnutrition, there was no differences between the methods. Complication rates were 10.9% for not malnourished patients and 28.6% for malnourished patients. Conclusion: Malnutrition is a common clinical problem in surgical patients that increases complication and mortality risks. Preoperatively detection of malnutrition and giving nutritional support to malnourished patients, may decrease complication rates.

Amaç: Hangi kritik Koronavirüs hastalığı-2019 (COVID-19) hastalarının fungal enfeksiyon geliştirme olasılığının daha yüksek olduğu konusu ve olası risk faktörleri belirsizliğini korumaktadır. Özellikle COVID-19 hastalarında invaziv fungal enfeksiyon gelişiminde kortikosteroidlerin ve diğer immün modülatörlerin rolü henüz aydınlatılamamıştır. Bu çalışmanın amacı, kritik COVID-19 hastalarında fungemi ilişkili klinik özellikleri, sonuçları ve risk faktörlerini tanımlamaktır. Gereç ve Yöntem: Etik kurul onamı sonrası üniversite hastanesi düzey 3 yoğun bakım ünitesi COVID-19 tanısı ile kabul edilen 550 hasta tarandı. Hastaların verileri kaydedilerek analizleri sağlandı. Bulgular: Taranan 550 hastadan fungal enfeksiyon tanısı alan 14 hasta çalışmaya dahil. Bu hastaların 5’i kadındı ve yaş ortalaması 55 yıl idi. Hastaların kabul anı karakteristik özellikleri Tablo 1’de gösterildi. Hastalar yüksek Akut Fizyoloji ve Kronik Sağlık Değerlendirmesi II ve Ardışık Organ Yetmezliği Değerlendirme Skoruna sahiptiler. Yoğun bakım yatış süresinde hastalara uygulanan tedaviler ve primer, sekonder sonlanımlar Tablo 2’de gösterilmekle beraber fungemi hastalarının %85,7’si kaybedildi. Hastalarda uzun süre hastane ve yoğun bakım yatışı gözlendi. Fungal enfeksiyon anındaki karakteristik özellikler ve fungal enfeksiyona ait bilgiler Tablo 3’te gösterildi. Bu hastalarda enfeksiyon öncesi uzun süre steroid kullanım zamanıyla göze çarparken beraber en sık odak periferik kan en sık üreyen mikroorganizma Candida türleri idi. Sonuç: Çalışmamız sonucunda en sık fungemi etkeni Candida türleri olarak belirlenmiştir. COVID-19 hastalarında normal popülasyonla karşılaştırdığımızda fungemi insidansı 1.000 yoğun bakım günü başına normal popülasyon daha yüksekti. Fungemi saptanan hastalarda %85,7 gibi yüksek mortalite oranları saptandı. Fungemi saptanan hastalarda mortalite için risk faktörleri uzun süre steroid kullanımı, uzun süre yoğun bakım yatışı olarak bulundu. Çalışmanın karşılaştırmalı analizleri yapılmaya devam edilmektedir. Ön analiz sonuçları sunulmuştur. [ABSTRACT FROM AUTHOR]

Amaç: SARS-CoV-2 enfeksiyonun neden olduğu küresel COVID-19 salgını halk sağlığını ve sağlık hizmetleri sistemlerini ciddi şekilde etkilemeye devam etmektedir. Bu çalışmada Türkiye yoğun bakım ünitelerinde (YBÜ) yatmakta olan COVID-19 olgularında aşılanma durumu, SARS-COV-2 varyantlarının prevalansı ve COVID-19 aşılarının etkinliğini saptamaya çalıştık. Gereç ve Yöntem: Sağlık Bakanlığı onayı ve yerel etik kurul izni alındıktan sonra çalışmamız ulusal çok merkezli hibrit tarzda iki fazlı olarak planlandı. İlk fazda 11 Ağustos 2021 tarihinde tek günlük nokta prevelans ile veriler toplandı. İkinci fazda yoğun bakım yatış tarihi baz alınarak 28 günlük mortalite değerlendirildi. Toplanan data SPSS 22.00 programında (IBM Corp., Armonk, NY, USA) analiz edildi. Independent samples t-test, Mann-Whitney U ve ki-kare ve Fisher’s Exact testleri kullanıldı. Aşı mortalite ile ilişkisini belirlemek amacıyla lojistik regresyon modeli oluşturuldu. İstatistiksel anlamlılık sınırı olarak p<0,05 belirlendi. Bulgular: Çalışmamıza 60 YBÜ’den toplam 921 COVID-19 pnömoni tanılı hasta dahil edildi. Olguların yaş ortalaması 65,42±16,74 olup, 448’i (%48,6) kadındı. Yatış günü medyan APACHE II skoru 16 (12-23), ve SOFA skoru 5 (4-8) idi. Altı yüz doksan dokuz (%75,9) kişide en az bir komorbid hastalık olup, hipertansiyon (%48,6) en sık saptanan idi (Tablo 1). Hastaların % 52,6’sı (n=484) aşısız, %36,2’si (n=333) çift doz CORONOVAC aşılıydı (Şekil 1). CO-RADS 5 radyolojik olarak en sık saptanan tutulum idi. Bilgisine ulaşılan 342 hastada en baskın varyantın delta (n=221, %64,6) olduğu görüldü. Oluşturulan lojistik regresyon modelinde 28 günlük mortalite oranı iki doz CORONAVAC aşılı hastalarda aşısız hastalara göre daha düşük saptandı (OR: 0,591, CI: %95: 0,413-0,848) (Tablo 2). Sonuç: Salgına karşı etkin aşılama programları hastalıkların yayılmasını ve mortaliteyi önlemede halen en etkili yöntem olarak kabul edilmektedir. Çalışmamızda YBÜ’de yatan hastaların yarısından fazlasının aşısız olduğunu, 28 günlük mortalitenin yaş, komorbidite sayısı, yüksek SOFA skorlarıyla ilişkili olduğunu saptadık. Bulgularımız iki doz CORONAVAC aşısının aşısızlara oranla mortaliteyi düşürdüğü yönündedir. [ABSTRACT FROM AUTHOR]

Giriş: COVID-19, yaklaşık 2 yıldır pandemiye sebep olan, asemptomatik hastalıktan kritik hastalığa kadar değişebilen kliniklerde seyredebilen ve mortalite ile sonuçlanabilen bir hastalıktır. Çalışmamızda COVID-19 tanısı alan ve şiddetli hastalık bulgusu olan hastaların klinik, laboratuvar ve radyolojik bulgularının mortalite üzerine etkisini değerlendirmeyi amaçladık.Gereç ve Yöntem: Çalışmamıza 01.01.2020-31.03.2021 tarihleri arasında Rize Devlet Hastanesi’nde enfeksiyon hastalıkları ve klinik mikrobiyoloji ile göğüs hastalıkları servislerinde takipli COVID-19 PCR pozitif hastalar dahil edildi. Retrospektif olarak hasta dosyalarından hastaların epidemiyolojik verileri, kronik hastalıkları, başvuru semptomları, laboratuvar bulguları, radyolojik bulguları kaydedildi. Hastalar sağ kalanlar ve kaybedilenler olarak gruplandırıldı. Radyolojik görüntülemelerinde pnömoni saptanan, oda havasında oksijen satürasyonu <%90 olan, takipne veya aksesuar respiratuvar kas kullanımı olan hastalar şiddetli hastalık olarak tanımlandı. Verilerin incelenmesinde SPSS 26.0 istatistik paket programı kullanıldı, istatistiksel anlamlılık düzeyi p<0,05 olarak kabul edildi. Bulgular: Yüz on sağ kalan ve 25 kaybedilen olmak üzere toplamda 135 hasta çalışmaya alındı. Hastaların yaş ortalaması 65,5±15,45 yıldı ve %61,5’i (n=83) erkekti. Kaybedilenlerin yaş ortalaması, sağ kalanlara göre istatistiksel açıdan anlamlı olarak daha fazlaydı (p=0,007). Koroner arter hastalığı (KAH) olan ve kronik böbrek hastalığı (KBH) olan hastalarda mortalite oranı sağ kalanlara göre istatistiksel açıdan anlamlı olarak daha yüksek saptandı (sırasıyla p=0,032, p=0,032). Kaybedilenlerde takipne oranı sağ kalanlara göre istatistiksel açıdan anlamlı olarak daha yüksek saptandı (p=0,001), gruplar arasında diğer başvuru semptomları ve laboratuvar bulguları açısından istatistiksel olarak anlamlı bir ilişki bulunmadı (p>0,5) (Tablo 1). Hastaların takibinde gün aşırı çekilen akciğer grafisi (PAAG) değerlendirildi, 76 (56,3%) hastada progresyon gözlendi. Kaybedilen hastalarda progresyon görülme oranı sağ kalanlara göre istatistiksel açıdan anlamlı olarak daha yüksek saptandı (p=0,004). Yapılan çoklu logistic regresyon analizi sonuçlarına göre ise kaybedilen hasta grubu için KAH bulunması ve PAAG’de progresyon gözlenmesi bağımsız birer risk faktörü olarak değerlendirildi (Tablo 2). Sonuç: COVID-19 hala gündemde olan ve üstesinden gelinebilmesi için yeni bilgilerin edinilmeye çalışıldığı bir hastalıktır. Çalışmamızda PAAG’de progresyon ve KAH bulunması kaybedilen hasta grubu için bağımsız risk faktörleri olarak bulunmuştur. Bu araştırmayla şiddetli COVID-19 hastalık seyrinde hastalığı kötüleştirebilecek faktörlerin tahmini yapılmıştır. Özellikle hastaların izleminde PAAG takibi ile progresyon saptanmasının, mortalite için bir risk faktörü olduğu bulunmuştur. Bu durum bize hastalık seyrinde radyolojik takibin de akılda tutulması gerektiğini göstermektedir. [ABSTRACT FROM AUTHOR]

La moitié des patients atteints d'endocardite infectieuse (EI) bénéficient d'un traitement chirurgical. Malgré des recommandations claires sur les indications et les délais opératoires, la décision reste difficile et doit prendre en compte plusieurs facteurs. On a réalisé une étude rétrospective au sein de l'hôpital Foch. Tous les patients opérés entre 2005 et 2018 pour une EI certaine ont été inclus. Les caractéristiques des patients, les indications et les délais opératoires, ainsi que la mortalité intra hospitalière, ont été notés. Le suivi des patients a été assuré par appel téléphonique. Cinquante-deux patients étaient opérés pour une EI entre 2005 et 2018. Les indications opératoires les plus fréquentes étaient la présence d'une fuite massive symptomatique, l'absence du contrôle de l'infection par le traitement médical et la présence de grosses végétations emboligènes. Le délai opératoire moyen était de 13,2 jours avec 56,5 % des patients opérés dans les 10 premiers jours. Les complications postopératoires les plus fréquentes étaient une insuffisance rénale aiguë dans 57,7 % des cas dont 9,6 % nécessitant la dialyse, un état de choc dans 50 % des cas, les troubles de rythme dans 40,4 % des cas, infectieuses dans 19,2 % des cas, troubles conductifs dans 25 % des cas dont 17,3 % nécessitant l'implantation d'un pace maker. La mortalité intrahospitalière était de 7,7 % et la durée moyenne d'hospitalisation était de 35 jours. La survie à un an et à 5 ans était de 95 % et de 85 %, respectivement. Les indications et les délais opératoires étaient conformes aux différentes recommandations. La mortalité intrahospitalière et au long cours était plutôt faible. In addition to medical treatment, half of the patients with infective endocarditis (IE) receive surgical treatment. Despite clear recommendations on the indications and the operating delays, the decision remains difficult and must take into consideration several factors. A retrospective study was performed at Foch Hospital. All patients operated for IE between 2005 and 2018 were included. Patient characteristics, indications and operating delays, as well as intrahospital mortality, were noted. Patient follow-up was provided by phone calls. Fifty-two patients were operated on for IE between 2005 and 2018. The most frequent surgical indications were the presence of a massive symptomatic regurgitation, an uncontrolled infection and large vegetations with embolism. The average operative delay was 13.2 days with 56.5% of patients operated within the first 10 days. The most common postoperative complications were acute kidney injury (AKI) in 57.7% of cases, with 9.6% of dialysis, shock in 50% of cases, rhythm disorders in 40.4% of cases, infectious complications in 19.2% of cases, conductive disorders in 25% of cases, of which 17.3% require a definitive pacemaker implementation. The intrahospital mortality was 7.7% and the average length of hospital stay was 35 days. Survival at one year and 5 years was 95% and 85%, respectively. The indications and the operating delays were conformed to international recommendations. Intrahospital and long-term mortality rate was low. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to compare the effects of malnutrition on mortality in immigrants and Turkish patients hospitalized in our ICU with the indication of gastrointestinal cancer. Method: This study was performed as a prospective observational study. One-hundred and three (41.3%) patients were Turkish and 146 (58.7%) were immigrants (all Syrian). Age, body mass index (BMI), duration of hospitalization, albumin value, and 30-day and 6-month mortality rates were evaluated. Also, the following assessment tools were calculated: Subjective Global Assessment (SGA), Nutrition risk screening-2002 (NRS), Charlson Comorbidity Index (CCI) Acute Physiology and Chronic Health Evaluation (APACHE) II and III. Results: In total, 150 (60.2%) patients had moderate (SGA B), while 71 (28.5%) patients had severe malnutrition (SGA C). The frequency of SGA C in the immigrants was significantly higher than Turkish citizens (p=0.004). The overall mortality rate in our study was 36.9%. No significant difference was found between Turkish citizens and immigrants in terms of overall mortality (p=0.592). Albumin value, APACHE II, APACHE III, CCI and NRS scores were significantly higher in those that died within 30 days. The APACHE 3 score was the most successful tool in predicting 30-day mortality according to ROC analyses. Conclusion: This study revealed that malnutrition is a significant problem for both immigrants and Turkish citizens hospitalized in the ICU. Although there are tools specific for malnutrition assessment, APACHE III score was found to have the highest likelihood to predict mortality. [ABSTRACT FROM AUTHOR]