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Author(s): Gokhan Sertcakacilar (corresponding author) [1,2]; Sunkar Kaya Bayrak [3]; Yaser Pektas [2]; Ipek Bostanci [2]; Gunes Ozlem Yildiz [2]; Mehmet Suleyman Sabaz [4] INTRODUCTION Transmission of coronavirus disease 2019 [...], Background and Aims: During the coronavirus disease 2019 (COVID-19) pandemic, health care workers are at a high risk of infection from aerosols. In this study, we compared the ease of using the aerosol box (AB) with the traditional method during internal jugular vein cannulation attempts (IJVCA). Methods: The study included 40 patients with COVID-19 who required central venous catheterisation during treatment in the ward. The patients were randomly allocated to one of the two protective equipment (PPE) groups and then randomly assigned to one of the five anaesthesiologists with at least 5 years of experience. Group P and A had both PPE and AB used, whereas Group P included patients where PPE was used alone. The physicians completed a survey after performing the procedure to evaluate the use of the AB. Results: The preparation for the procedure and procedure durations were observed to be statistically longer in Group P and A (P = 0.002 and P = 0.001, respectively). The first attempt in Group P and A was unsuccessful in six patients, whereas the first attempt in Group P was unsuccessful in only two patients (P = 0.235). Anaesthesiologists described difficulty with manipulation during the procedure, discomfort using the box, and resulting cognitive load increase in Group P and A. Conclusion: The IJVCA procedures were faster and easier and had greater satisfaction for physicians when the AB was not used. Also, the high complication rate, including carotid artery punctures and disruption of sterility and PPE, albeit not statistically significant, has clinical implications. Therefore, we do not recommend the use of ABs for IJVCA. Keywords: Aerosols, catheterisation, central venous, COVID-19, personal protective equipment, SARS-CoV-2

Objective: By comparing viral sepsis caused by severe acute respiratory syndrome coronavirus-2 with pneumosepsis caused by other pathogens, we aimed to compare the pathogen-host relationship, organ damage affecting the clinic, and similar and different features of the two types of sepsis. Materials and Methods: A total of 414 patients diagnosed with critical coronavirus disease-2019 (COVID-19) between 2019 and 2021 and 303 pneumosepsis cases that met the diagnostic criteria for sepsis-3 between 2016 and 2019 admitted to the anesthesiology and reanimation intensive care unit (ICU) were retrospectively screened. The patient's demographic data, mortality rates, length of stay in the ICU, development of secondary organ dysfunction, presentation values of laboratory and mechanical ventilation, and changes within the 1-week follow-up were compared. Results: The sequential organ failure assessment scores were significantly higher in the COVID-19 sepsis group at presentation (8.2±2.9 vs. 7.2±3.7; p<0.0001) and during follow-up (8.9±4.9 vs. 7.8±3.7; p=0.002). The mean age of the patients was 65.4±17.2 years in the non-COVID-19 sepsis group and 57.9±17.1 years in the COVID-19 sepsis group (p<0.0001). The number of days on mechanical ventilation was significantly higher in the COVID-19 sepsis group (p=0.018). Mortality was detected in 299 patients (41.7%) in total, with no significant difference being observed between the two groups (p=0.592). Conclusion: Despite the patient population having a lower mean age and fewer comorbidities, organ dysfunction was higher in COVID-19 sepsis patients during admission to the ICU and follow-up. While the pathogen causing sepsis can be brought under control with rapid diagnosis and appropriate antimicrobial treatment, organ damage cannot be controlled with appropriate antiviral treatment in COVID-19 sepsis. In COVID-19 sepsis, secondary organ damage may be more evident as a result of damage and immunomicrothrombosis, which causes high mortality and morbidity, the mechanism of which has not yet been fully elucidated. [ABSTRACT FROM AUTHOR]

Background: The number of geriatric patients in the intensive care unit (ICU) is increasing day by day in line with the increase in the population. The present study evaluated the relationship between the presence of acute kidney injury (AKI) and mortality in geriatric patients, who are increasingly seen in the ICU. Methods: This retrospective study was conducted in a tertiary-level ICU of a public hospital in Istanbul, Turkey. The data of 2154 patients aged 65 and over, who were followed up in the ICU between January 2013 and January 2020, were collected and digitally analyzed using Structured Query Language. Results: The patients were divided into two groups as 1286 (59.7%) who developed AKI and 868 (40.3%) who did not develop AKI. Patients with AKI stay in the ICU longer than patients who did not develop AKI (median 5.91 vs. 3.44 days, p < 0.05). ICU mortality was 46.2% in patients with AKI and 25.8% in patients without AKI (p < 0.001). All stages of AKI were found to increase mortality (p < 0.05). The probability of mortality in patients above 85 years of age who developed AKI was 1.7 times higher compared to that of geriatric patients who developed AKI younger than 75 years (OR: 1.749; 95% CI: 1.099–2.785). While the increase in sequential organ failure assessment score, ventilator workload and lactate level, need for dialysis, and development of pressure sores was associated with increased mortality in geriatric patients with AKI, an increase in body mass index was associated with a decrease in mortality (OR: 0.961; 95% CI: 0.929–0.995). Conclusion: AKI is associated with ICU mortality in geriatric patients and it increases morbidity. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effects of perioperative goal-directed fluid therapy (GDFT) on intraoperative fluid balance, postoperative morbidity, and mortality. Methods: This is a prospective randomized study, and 90 patients who underwent elective open gastrointestinal cancer surgery between April 2017 and May 2018 were included. Patients were randomized into 2 groups that received liberal fluid therapy (the LFT group, n=45) and goal-directed fluid therapy (the GDFT group, n=45). Patients' Colorectal Physiologic and Operative Severity Score for the enUmeration of Mortality and Morbidity (CR-POSSUM) physiological score, Charlson Comorbidity Index (CCI), perioperative vasopressor and inotrope use, postoperative AKIN classification, postoperative intensive care unit (ICU) hospitalization, hospital stay, and 30-day mortality were recorded. Results: The volume of crystalloid used perioperatively and the total volume of fluid were significantly lower in the GDFT group compared to the LFT group (P<0.05). CR-POSSUM physiological score and CCI were significantly higher in the GDFT group (P<0.05). Although perioperative vasopressor and inotrope use was significantly higher in the GDFT group (P<0.05), postoperative acute kidney injury development was not affected. Postoperative mortality was determined to be similar in both groups (P>0.05). Conclusion: Although GDFT was demonstrated to be a good alternative method to LFT in open gastrointestinal cancer surgery, and it can prevent perioperative fluid overload, and the postoperative results are comparable in the two groups. [ABSTRACT FROM AUTHOR]

Objective: To compare the efficacy of pulsed-dose corticosteroids (≥250 mg methylprednisolone, 3 days) and tocilizumab in treating COVID-19-related hyperinflammation. Methods: This prospective observational study included RT-PCR positive COVID-19 patients with acute respiratory distress syndrome, who were admitted to the COVID-19 Adult Intensive Care Unit of Prof Dr. Murat Dilmener Emergency Hospital (Istanbul, Turkey) between December 1, 2020 and February 28, 2021. Clinical, laboratory and radiological examinations were used to diagnose COVID-19 associated hyperinflammation. Three cohort groups were formed: the pulsed-dose corticosteroids group (250 mg methylprednisolone for 3 days), the tocilizumab group (8 mg/day single dose or 400 mg/day for 2 days), and the combined group (pulsed-dose corticosteroid+tocilizumab). The difference in mortality rates among the groups was compared primarily. The most common cause(s) of death was determined. Furthermore, adverse events (secondary infection, acute kidney injury, arrhythmia, gastrointestinal system bleeding) for 28 days were recorded. Results: A total of 60 patients were included in this study, with 20 patients in each group. There was no statistically significant difference between the 3 groups in mortality rates (55% in the pulsed corticosteroid group, 60% in the tocilizumab group, 50% in the combined group, χ2=0.404, P=0.817). Infectious causes were found to be the most common cause of mortality in all the three groups, and no difference was found between them (χ2=0.404, P=0.817). There was also no difference in the development of adverse events such as secondary infection, acute kidney injury, arrhythmia, and gastrointestinal bleeding among the groups (P>0.05). Conclusions: Corticosteroids can be used instead of tocilizumab to treat hyperinflammation in COVID-19 patients with acute respiratory distress syndrome. [ABSTRACT FROM AUTHOR]

Introduction: This study was intended to evaluate the relationship between the presence of obesity in geriatric patients, which is becoming more and more common in the intensive care unit, with the intensive care process and mortality. Materials and Method: In this retrospective study, data on 2,114 patients aged 65 and over who were followed in the intensive care unit between January 2013-January 2020 were obtained electronically and evaluated. Results: Patients were divided into two groups of 1,632 (77.2%) nonobese and 482 (22.8%) obese patients. It was determined that acute kidney injury development was more common in obese patients (326; 67.6%) than non-obese patients (937; 57.4%) and obese patients required more frequent dialysis (p <0.05). It was determined that obese patients required more frequent mechanical ventilator support, had higher positive end-expiratory pressure and peak pressure Work of Breathing ventilator values, and had lower compliance (34 [29–41]) (p<0.05). Although obese patients were given fewer daily calories than non-obese patients, their mean blood glucose was higher (p <0.001). Obese patients (5.70 [2.43–12.31]) had longer intensive care durations than non-obese patients (4.41 [2.01–10.45]) (p <0.05). Finally, intensive care mortality was determined to be 37.6% (181) in obese patients and 36.0% (588) in non-obese patients (p>0.05). Conclusion: Obese patients’ increased complication rate and duration of stay in the intensive care show that obesity increases intensive care morbidity in geriatric patients, but it has no relationship with mortality. [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]

Objectives: To assess the outcomes of the intensive care of Syrian refugees under temporary protection (SRUTP). Methods: The sample of the study was composed of 110 SRUTP patients who were treated at a tertiary intensive care unit (ICU) between 2013 and 2019 in Istanbul, Turkey. Baseline information and clinical data of the patients were collected by scanning the hospital's electronic database and clinical decision support system. Results: The mean length of ICU stay was 97.6 (36.3-187.8) h. Among the patients, 71 (64.5%) had comorbid diseases, and ICU mortality was 40%. The median cost of health care for each patient was 2 144 (1 060-4 471) USD, and the total health care cost of all patients was 534 012USD. Conclusions: Use of vasoactive drug, hemodialysis application, and low Glasgow Coma Scale scores are independent risk factors of the mortality. More researches are needed to clearly reveal the health and cost consequences of war. [ABSTRACT FROM AUTHOR]

Copyright of Turkish Journal of Intensive Care 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: To investigate the code blue application at a training and research hospital in Turkey. Methods: The code blue declaration forms and the hospital database with 238 complete records between January 2016 and July 2017 were collected. The form involved individual characteristics, the reason for issuing the code blue call, the unit and block where the code was given, time and location related properties such as working time and arrival duration, properties regarding the intervention process such as its type, duration or result. The 24-hour and 30-day long survival data of the patients to whom cardiopulmonary resuscitation was implemented were obtained from the hospital database, or from their relatives. The influencing factors of arrival duration were analyzed. Results: The median duration of arrival was 2.14 (2.00-3.02) min. Code blue applications were performed more frequently in Departments of General Surgery, Internal Medicine, Orthopaedics, and Cardiology Clinics. Half of the code blue calls were due to cardiac arrest; the other half was due to shortness of breath or respiratory distress, syncope, and respiratory arrest. Three-out- of four code blue calls were treated with orotracheal intubation and cardiopulmonary resuscitation, or only orotracheal intubation or only medical treatment; one-fourth of the calls were not intervened. Altogether, 72.36% of the code blue calls patients were intervened; 69.35% of them were made both orotracheal intubation and cardiopulmonary resuscitation, and 20.5% of them were made only orotracheal intubation and 10.55% of them made only medical treatment. It was found that giving the code blue day or night had no effect on the time to reach the area where the code was given. Similarly, it was found that giving the code blue within daytime or night shift had no effect on the time to reach the area where the code was given. (P>0.05). The survival rates were 39.1% within the first 24 h and 18.1% within the first 30 d. Conclusions: Applications of code blue should be analyzed at regular intervals as clinical quality indicators. Reasons for wrong calls should be determined. The duration of reaching locations where calls are made should also be decreased. [ABSTRACT FROM AUTHOR]

Copyright of Medical Journal of Bakirkoy 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 Medical Journal of Bakirkoy 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.)

Introduction: Extracorporeal carbon dioxide removal (ECCO2 R) is a respiratory support method that solely offers decarboxylation with minimal blood flow (0.3-1.0 L/min). Here we present the ECCO2 R treatment in a patient who was intubated due to hypercarbic respiratory failure after an asthma attack. Case: A 18-year-old male patient with a diagnosis of asthma admitted to the emergency room with respiratory distress. He was suffering with persistent wheezing and dyspnea. Physical examination showed decreased auscultation in both lungs. Chest X-ray was normal and the blood gas analysis showed a deep respiratory acidosis (Ph: 6.98, pCO2 : 162 mmHg, pO2 : 208 mmHg, HCO3 : -26.4, BE: -1.6). The patient was intubated and admitted to the intensive care unit (ICU). He was treated with budesonide + salbutamol + ipatropiumbromide + theophylline + intravenous steroid and magnesium sulfate during that period. Neuromuscular blocking agent was added to treatment in addition to deep sedation due to ongoing bronchospasm. Hypercapnia and respiratory acidosis was persist despite high mechanical ventilatory support (PEEP: 10 cmH2O, Psupport: 35 cmH2O, respiratory rate: 30, FiO2 :%40). The VV-ECCO2 R (multi ECCO2 R®- Fresenius Medical Care) was started on the 2nd day of hospitalization. The extracorporeal blood flow was set at 300-350 mL/min, while the sweep gas flow was adjusted to be 3-6 L/min according to the pCO2 value. Unfractionated heparin was used for systemic anticoagulation. In times hypercarbia regressed gradually, blood gas parameters improved and ventilatory supports decreased (Table 1). He was successfully weaned from the ECCO2 R on the 5th day and then extubated. He was discharged to the ward with nasal oxygen support. Discussion: Most asthma attacks can be treated but some patients remain uncontrolled despite adequate therapy. The use of ECCO2 R has been shown for the possibility of earlier extubation after severe asthma attack who need invasive-mechanical ventilation. In our patient, who was suffering from life-threathening asthma attack and finally discharged from the ICU, VV-ECCO2 R corrected hypercapnia and acidosis, allowed the reduction of other supportive measures and the favored the weaning from mechanical ventilation. [ABSTRACT FROM AUTHOR]

Introduction: Streptococcus constellatus, a normal pathogen found in the oropharyngeal, vaginal or gastrointestinal flora has a potential to cause empyema, and necrosis of different organs, especially when associated with comorbid conditions and risk factors. The purpose of this case report is to share our clinical experience with streptococcus constellatus abscess in a diabetic patient with a history of periodontal procedure. Case: A 64-year-old female patient who had a recent history of periodontal intervention was admitted to the emergency department with abdominal pain. The CT imaging showed abscess formation in the liver (Figure 1). After surgery metronidazole and cefuroxime treatment was started due to S. constellatus growth in the abscess culture. Three weeks later, the patient was admitted to the emergency room with unconsciousness. She was intubated. An abscess formation with a 2.5 cm diameter in the periventricular white matter was observed on cranial CT (Figure 2). Amphotercin B, metronidazole, vancomycin and meronem antibiotherapies were started in the following days. There was no improvement in consciousness. Control cranial imaging showed no regression of the intracranial abscess. Desired clinical improvement could not be achieved so intraventricular vancomycin treatment was started based on the S. constellatus growth. Patient died due to septic shock at the 14th day of ICU stay. Discussion: Streptococcus constellatus have a potential to cause invasive infection and when suspected immediate surgical approach along with IV antibiotics should be start. In our diabetic patient, rapid progression of lesion had occured despite surgery and broad-spectrum antibiotics. It should always be kept in mind that S. anginosus group infection dangerous and can occur in immunocompromised individuals who have risk factors [ABSTRACT FROM AUTHOR]

Introduction: Extracorporeal carbon dioxide removal (ECCO2 R) is a respiratory support technique that provides only decarboxylation with low blood flow (0.3-1.0 L/min) without making a significant difference in blood oxygenation. In this report, we planned to present our clinical experience with ECCO2 R in a patient who developed hypercarbic respiratory failure due to exacerbation of chronic obstructive pulmonary disease (COPD). Case: A 74-year-old male patient with hypertension and diabetes, who used a BiPAP device and oxygen concentrator at home due to COPD, presented to the emergency department with shortness of breath and respiratory distress. During the follow-up, the patient who had a hypercapnia and admitted to the intensive care unit (ICU). The VV-ECCO2 R (multi ECCO2 R ®-Fresenius Medical Care) was started on the 3rd day of hospitalization for the patient who needed NIMV for an average of 16-18 hours per day and remain hypercarbic despite NIMV support. The extracorporeal blood flow was set at 200 mL/min and maintained stable, while the sweep gas flow was adjusted to be 3-5 L/min according to the PCO2 value. The patient was followed with high flow oxygen support without need for NIMV from beginning of the ECCO2 R. The patient, whose hypercarbia regressed, was weaned from ECCO2 R at the 40th hour (Table 1). The oxygen support was maintained with a simple face mask and he was transferred to the service on the 13th day of hospitalization. Discussion: Current evidence regarding the use of ECCO 2 R in patients with obstructive diseases remains limited. Patient selection, type of ECCO2 R device used and anticoagulation strategy seem important in order to benefit from ECCO2 R. In our patient with severe exacerbation of COPD, we decided to treat the respiratory acidosis by removing CO2 with an artificial lung. The use of ECCO2 R allowed avoiding intubation and invasive mechanical ventilation and finally he was discharged from the ICU. [ABSTRACT FROM AUTHOR]

Introduction: Acinetobacter baumannii (AB) is a predominant cause of nosocomial infections across the globe. It assumed that transmission is due to interactions between healthcare providers, patients, and contaminated fomites in the environment. Here, we present the transmission of AB in patients who had long-term soil exposure under the debris during earthquakes. Case: Case 1: A 34 years old male patient was admitted to our intensive care unit (ICU) 24 hours after decompressive craniectomy due to subdural hematoma after being under the rubble after the earthquake. 10,000,000 cfu/mL AB was detected in the deep tracheal aspirate (DTA) culture taken upon admission. Case 2: A 59 years old male patient was admitted to our ICU after staying under the rubble for 24 hours after the earthquake. Thirty minutes of CPR was applied after the crush syndrome. AB (500,000 cfu/mL) was detected in the patient’s DTA culture. In the following days,treatment was started due to the development of pnomosepsis. Case 3: A 31-years old male patient was trapped under the rubble for 18 hours. He was admitted to the ICU 36 hours after accident with a history of CRUSH syndrome. One million cfu/mL AB was founded in the DTA culture and 50,000 cfu/mL in the nasal swab culture at the admission. Systemic antibiotherapy was started at the 4th day of hospitalization due to septic shock. Discussion: AB is associated with a higher mortality rate among infected patients in the last years. It was found that a dry and hot environment was a risk factor for the transmission of AB in American soldiers who went to conflict zones in Northern Iraq. AB was detected in the first admission cultures of our patients, and antibiograms showed that there was no flora element belonging to our hospital. Although acinetobacter is thought to be a hospital-acquired pathogen, it should be kept in mind that it is a risk factor for colonization in patients who have been trapped under debris. [ABSTRACT FROM AUTHOR]

Amaç: Koronavirüs hastalığı-2019 (COVID-19) ilişkili immün disregülasyon ve hiperenflamasyon ile gelişen makrofaj aktivasyon sendromu (MAS) doku hasarına yol açarak hastalığın en ağır formuna ilerleyebilir. Bu çalışmada sitokin fırtınası gelişen kritik COVID-19 hastalarında interlökin-6 reseptör antagonisti olan Tocilizumab ile sitokin uzaklaştırıcı hemoadsorbsiyon tedavilerinin etkinlikleri karşılaştırıldı. Gereç ve Yöntem: Etik kurul onamı alındıktan sonra prospektif kohort şeklinde planlanan çalışmamıza YBÜ’nde tedavi edilen ve sitokin fırtınası gelişen COVID-19 hastaları alındı. Yapılan güç analizinde çalışmamız için 68 hasta gerektiği saptanmıştı. Numerik verilerin karşılaştırılmasında, ındependent samples t-testi veya Mann-Whitney U testi kullanıldı. Kategorik değişkenlerin karşılaştırılmasında ki-kare testi veya Fisher’sexact testi kullanıldı. İstatistiksel anlamlılık sınırı olarak p<0,05 belirlendi. Bulgular: Her iki grupta demografik bilgiler, YBÜ yatış APACHE II VE SOFA skorları benzerdi. Sitokin uzaklaştırıcı (Grup 1) ve Tocilizumab (Grup 2) tedavilerinin biyokimyasal parametreler üzerindeki etkileri karşılaştırıldığında Tocilizumab grubunda 0. günde D-dimer ve 7. günde CRP seviyeleri anlamlı düşük saptandı (p<0,05). Grup içi karşılaştırmada her iki grupta da tedavi ile ferritin, prokalsitonin, CRP ve fibrinojen düzeylerinin düştüğü, lenfosit sayısının ise arttığı belirlendi (p<0,05) (Tablo 1). Entübasyon ve MV süresi Grup 1’de Grup 2’ye göre anlamlı yüksekti (p<0,05). Sekonder enfeksiyon sıklığı Grup 1’de (24; %70,6) Grup 2’ye (16; %47,1) göre anlamlı yüksek saptandı (p<0,05). Grup 1, Grup 2 ile karşılaştırıldığında akut böbrek hasarı ve hemodiyaliz ihtiyacı daha yüksek, YBÜ ve hastane yatış süreleri daha uzundu (p<0,05). Yirmi sekiz günlük mortalite gruplar arasında anlamlı farklılık göstermedi. Sonuç: SARS-CoV-2 enfeksiyonuna yönelik spesifik antiviral ajan henüz bulunmamaktadır. MAS’de kullanılan immünomodülatuvar ajan ve sitokin adsorbsiyon tedavilerinin sonuçları tartışmalıdır. Çalışmamızda YBÜ’müzdeki hastalık şiddeti benzer COVID-19 hastalarında gelişen MAS’de tedavide kullanılan sitokin hemoadsorbsiyon ve Tocilizumab tedavilerinin benzer sağkalıma yolaçmakla birlikte sitokin filtresi kullanımı Tocilizumab tedavisine göre sekonder enfeksiyon, entübasyon sıklığı, MV süresi ile YBÜ yatış süresinde uzamaya neden olmaktadır. Daha az invaziv olması gözönüne alındığında Tocilizumab tedavisinin MAS tablosunda akla getirilmesi uygun görülmektedir. [ABSTRACT FROM AUTHOR]

Filyos, which is a coastal town located at the Western Black Sea region of Turkey, in Çaycuma, Zonguldak, has a significant archeological past, and is home of important archeological ruins. Especially during the 4th and 3rd centuries B.C., Filyos had a strategic role in its region, and today it is classified as a historic site. Beside the ancient city of Filyos which is located at the east side, the town is also important for its city walls, the chapel and ruins of an ancient harbor, all from the Byzantine period. A thorough design process that considers the ecological features of the region, users' demands and the archeological features is crucial for the landscape projects in the town. This study aims to reshape the coastline of Filyos to attract touristic activities and to meet the recreational demands of people, while preserving the archeological and ecological features of the region. In this paper, design principles for the use and organization of Filyos coastline are presented, and a survey is conducted to determine users' demand. In the conclusion section, design stages are prepared and strategies for revitalization on the Filyos coastline are discussed. [ABSTRACT FROM AUTHOR]

Crataegus L. (Hawthorn) taxa have approximately 200 species around the world. Some regions in Turkey are accepted by Dönmez [12] as genetic diversity centers for these taxa, and Western Black Sea Region is one of them. From this regard, Karabük, Yenice and Bartin in Western Black Sea Region were selected as study areas. The main aims of the study are to determine Crataegus L. taxa naturally dispersed in the study areas, and to establish their usage opportunities in landscape applications. In this context, Crataegus L. samples collected in the study areas were identified. In accordance with classification criterias, functional and aesthetic features in planting design were determined by performing examinations on Crataegus L. taxa used in different landscape applications (campus and refuge arrangements) in Ankara. Consequently, eight Crataegus L. taxa, of which two were endemic, were detected in the study areas. In addition, the importance and necessity of benefiting from functional, aesthetic and economic aspects of natural Crataegus L. taxa were emphasized to improve the success rates of landscape applications in Western Black Sea Region. [ABSTRACT FROM AUTHOR]

Plant materials have an essential importance in landscape architectural applications. The use of locally natural-growing plants is generally useful, and provides facilities in the selection of plant material. The research for this work was performed in Bartin, Karabük and Zonguldak, located in the Western Black Sea region of Turkey. In this region, two parts of Karabük, named Keltepe and Yenice, have the richest natural vegetation. In this study, 101 woody and 417 herbaceous (a total of 518) plant species in land- scape architecture have been investigated. Shape and colour of the flower, blossoming time and its duration, have been observed. In addition, each plant type was evaluated separately for its possible use in landscape planning for the investigated area. A total of 92 of the investigated plants were collected for the first time and identified as new species. The plant species which are naturally distributed in the floral regions are 104 „Euro-Siberian"; 61 „Mediterranean Element"; 34 „Euxine"; 96 „Widespread"; 7 „Hyrcano-Euxine"; 8 „Irano-Turanien"; and 210 unknown species. Here, the Compositae family showed the highest number of genera (41) and species (66), respectively. From 11 endemic plants with defined landscape value, the species Dianthus setisquamosus, Dianthus kastembeluensis, Centaurea cadmea, Centaurea kilaea, and Centaurea inexpectata were at the top, but the other endemic species should also be taken as being valuable for planting. Later on, the use of Cardamine sp., Silene sp., Tamarix sp., Pterocarya fraxinifolia, Cercis siliquastrum, Origanum sp., Muscari sp. and Cyclamen sp. in landscape regulations should be provided. [ABSTRACT FROM AUTHOR]

Amaç: Koronavirüs hastalığı-2019 (COVID-19) salgını, yoğun bakım ünitelerinde (YBÜ) ciddi morbidite ve mortaliteye neden olmaktadır. Pandemi sürecinde tedavi stratejilerden biri, iyileşen hastalardan elde edilen konvelesan plazmada (KP) bulunan spesifik antikorların infüzyonudur. Bu çalışmada YB ünitemizde yatan kritik COVID-19 hastalarında standart tedaviye eklenen KP uygulamasının mortaliteye olan etkisi araştırıldı. Gereç ve Yöntem: Etik kurul onayı alındıktan sonra retrospektif kohort şeklinde planlanan çalışmamızda 1 Nisan 2020-1 Kasım 2020 tarihleri arasında YBÜ’de tedavi edilen 255 kritik COVID-19 hastası değerlendirildi. Yapılan güç analizinde çalışmamız için en az 116 hasta gerektiği hesaplandı. Numerik verilerin karşılaştırılmasında, independent samples t-testi, bu testin varsayımları sağlanamadığında Mann-Whitney U testi kullanıldı. Kategorik değişkenlerin karşılaştırılmasında ki-kare testi, kikare testinin şartları sağlanamadığında ise Fisher’s-exact testi kullanıldı. KP kullanımının mortalite ile ilişkisini belirlemek amacıyla lojistik regresyon modeli kullanıldı. İstatistiksel anlamlılık sınırı olarak p<0,05 belirlendi. Bulgular: Hastalar: Standart tedavi alan (n=153; %60,0) ve KP uygulanan hastalar (n=102; %40,0) olarak 2 gruba ayrıldı. Demografik bulgular her iki grupta benzerdi. YBÜ takibi sırasında KP verilen 52 (%51,0) ve KP verilmeyen 108 (%70,6) hasta entübe edildi (p<0,05). Mekanik ventilasyon süresi açısından iki grup arasında anlamlı fark yoktu. Yirmi sekiz günlük mortalitenin KP alan hastalarda daha düşük olduğu (p<0,05), KP transfüzyonundaki her bir günlük gecikmenin mortalite olasılığını 1,3 kat artırdığı (OR: 1,369; CI 95%: 1,155-1,622), APACHE II skoru >15 olan hastalarda KP transfüzyonunun mortaliteyi düşürmediği saptandı (Tablo 1). Sonuç: KP etkinliği transfüzyonunun zamanlaması ve kritik hastalığın şiddetinden etkilenmektedir. COVID-19 hastalarında KP kullanımının mortalite ile olan ilişkisini araştıran çalışmaların sonuçları birbirlerine zıt yöndedir. Sonuçlarımız YB ünitemizde takip edilen benzer klinik özelliklere sahip COVID-19 hastalarında standart tedavinin yanında erken dönemde KP kullanımının mortaliteyi düşürdüğünü, yüksek APACHE II skoru olan hastalarda ise KP transfüzyonunun etkin olmadığı yönündedir. [ABSTRACT FROM AUTHOR]