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Öğe Clinical correlation of biopsy results in patients with temporal arteritis(Assoc Medica Brasileira, 2017) Yuksel, Olkan; Guclu, Orkut; Tastekin, Ebru; Halici, Umit; Huseyin, Serhat; Inal, Volkan; Canbaz, SuatObjective: Temporal arteritis is systemic vasculitis of medium and large sized vessels. The lowest incidence rates were reported in Turkey, Japan and Israel. We aimed to investigate the results of patients with biopsy-proven temporal arteritis and those classified according to the American College of Rheumatology criteria from a low-incidence region for temporal arteritis. The results of our study are noteworthy, since there is limited data on pathologic diagnosis of temporal arteritis in Turkey. Method: We studied the medical records, laboratory findings such as erythrocyte sedimentation rate and C-reactive protein levels, biopsy results, and postoperative complications of all the patients operated for temporal artery biopsy at our clinic. We used the computerized laboratory registry that keeps all records of 42 consecutive temporal artery biopsy results from January 2011 to December 2016. Results: The mean age was 66 +/- 12.5 years. The most common manifestations on admission were temporal headache, optic neuritis and jaw claudication, respectively. Temporal artery biopsy results confirmed tempoal arteritis in eight out of 42 (19%) patients. There was no statistically significant difference between biopsy-positive and biopsy-negative groups in terms of sex, age, erythrocyte sedimentation rate, C-reactive protein and biopsy length. Conclusion: We were not able to find a correlation between the analysis of biopsy results and clinical evaluation of patients with temporal arteritis. We suggest that diagnosis of temporal arteritis depends on clinical suspicion. Laboratory examination results may not be helpful in accurate diagnosis of tempoal arteritis.Öğe Does ultrasonographic assessment of gastric antrum correlate with gastric residual volume in critically ill patients? A prospective observational study(Springer Heidelberg, 2021) Taskin, Gurhan; Inal, Volkan; Yamanel, LeventThis study aimed to evaluate the relationship between ultrasonographic gastric antral measurements and aspirated gastric residual volume (GRV) in mechanically ventilated critically ill patients receiving enteral nutrition (EN). This prospective observational study included 56 enterally-fed critically ill patients in one-year period. All imaging procedures were done at 30-degree head-of-bed elevation and supine position on epigastric region of abdomen with 2.5-6 MHz convex-array probe just before routine GRV aspiration. The antral cross-sectional area (CSA) was calculated by measuring the anteroposterior (dAP) and craniocaudal diameters (dCC) of the gastric antrum. Total 283 ultrasonographic gastric antrum imaging procedures were done. In only eight (2.82%) attempts, the antrum could not be visualized due to inhibition from intra-gastric air or gas in the surrounding intestinal lumen. The calculated mean antral CSA was 568.15 +/- 348.37 mm(2) (103.43-2,846.30). The antral CSA correlated significantly with aspirated GRV, and the antral CSA increased linearly with increasing aspirated GRV (R-2 = 0.73, p < 0.0001). In Receiver operating characteristic (ROC) analysis of antral CSA >= 920 mm(2) (mean + 1*SD) for estimating aspirated GRV, the area under the curve (AUC) was 0.848 (95% CI, 0.76 similar to 0.93) (p < 0.0001), and ROC analysis of antral CSA to discriminate aspirated GRV >= 250 mL showed a significant relation (AUC = 0.969, 95% CI 0.94 similar to 0.99, p < 0.0001). Ultrasonographic measurement of gastric antral CSA is an easy and reliable bedside procedure to estimate GRV in critically ill patients receiving EN in 30-degree head-of-bed elevation and supine position. Trial registration number: NCT04413474, date of registration: June 17, 2020, retrospectively registered.Öğe Evaluation of Basic Parameters for Prediction of ICU Mortality(Turkish Soc Medical & Surgical Intensive Care Medicine, 2021) Tabakoglu, Nilgun; Inal, VolkanAim: The performance of common mortality prediction models in the intensive care units (ICU) are extensively validated, predominantly in high-income countries. Simple and fast models with region specific features are needed. Study design: Retrospective case-control study Methods: We reviewed the medical records of 1057 ICU-admitted patients within three years. Patient survival was defined as discharge before 28 days. Multivariate logistic regression modeling was applied, basic parameters were selected, and a simple model was tried using four of them (age, albumin, platelet, C-reactive protein); as Quick Prediction of Mortality (Qpm) score, and then tested. The Qpm score predictions were compared to calculated APACHE II predicted mortality (APM) score predictions. Both scores were then weighted by calculated standardized mortality ratios (SMR). Results: 933 patients were included into the analyses. The patients' overall observed mortality rate was 47%. APACHE!! score prediction was 49% (p< 0.001, AUC= 0.810, r: 0.518). Qpm score prediction was 57% (p< 0.001, AUC= 0.699, r: 0.338). The SMR for Qpm was 0.82 in comparison to APM score SMR = 0.96. Conclusion: This simple prediction model has showed an acceptable performance in our ICU sample and needs to be prospectively evaluated for feasibility. In addition, further studies could be planned for external evaluations and validations in different settings.Öğe Evaluation of Pre-Delirium Score in Intensive Care Patients(Galenos Yayincilik, 2018) Inal, Mehmet Turan; Memis, Dilek; Inal, Volkan; Uyar, Ahmet Senol; Tek, Seyda Cigdem; Ciftci, Taner; Efe, SerdarObjective: Delirium is frequently seen in intensive care patients and causes prolongation of mechanical ventilation and intensive care stay. In intensive care patients, the pre-delirium score is a test used to detect delirium. We aimed to determine the prognostic value of the pre-delirium score in patients who stayed more than 24 hours in our intensive care unit. Materials and Methods: Between January 1, 2016 and December 31, 2016, pre-delirium scores were calculated for all patients stayed more than 24 hours in surgery, reanimation and internal medicine intensive care units. Pre-delirium score >= 50 was accepted as group 1 and <50 was accepted as group 2. The groups were compared with each other in terms of gender, age, Acute Physiology and Chronic Health Evaluation (APACHE II) scores, duration of hospitalization and mortality rates. Results: While a high pre-delirium score was determined in 196 patients (39.2%), a low pre-delirium score was determined in 304 cases (60.8%) (group 2). In group 1, the mean age was 68.47 +/- 15.83 years and the mean APACHE II score was 22.47 +/- 7.75; in group 2 the mean age was 59.18 +/- 18.48 years and the mean APACHE II score was 15.71 +/- 7.87, which was found significantly higher than group 1 (p<0.05). In group 1, the duration of hospitalization was 19.93 +/- 23.46 days and the mortality rate was 65.3%; in group 2, the duration of hospitalization was 13.02 +/- 20.01 days and the mortality rate was 40.5%. Significant difference determined in terms of duration of hospitalization and mortality (p<0.05). Conclusion: Early recognition and treatment of delirium will lead to significant improvements in the prognosis of intensive care unit patients. We think that the predelirium score can also be used as an important prognostic test in intensive care unit patients.Öğe Extracorporeal carbon dioxide removal (ECCO2R) in COPD and ARDS patients with severe hypercapnic respiratory failure. A retrospective case-control study(Tubitak Scientific & Technological Research Council Turkey, 2021) Inal, Volkan; Efe, SerdarBackground/aim: Treatment of severe hypercapnic respiratory failure (HRF) has some challenges in patients with chronic obstructive pulmonary disease (COPD) and acute respiratory distress syndrome (ARDS), especially when lung protective ventilation (LPV) strategies are required. Extracorporeal CO2 removal (ECCO2R) therapy is an emerging option to manage hypercapnia while allowing LPV in these cases. However, further data on ECCO2R use is still needed to make clear recommendations. Materials and methods: This study was conducted on patients admitted to intensive care unit (ICU) between January 1st, 2016 to December 31st, 2019. The medical records were retrospectively scanned in institutional software database. Patients who received invasive mechanic ventilation (iMV) support due to severe HRF related to COPD or ARDS were included in the analyses. Patients were grouped according to treatment approaches as that ECCO2R therapy in addition to conventional treatments and conventional treatments alone (controls). Groups were compared for 28-day survival, iMV duration, and length of stay (LOS). Results: ECCO2R therapy was noted in 75 of the cases among included 395 patients (COPD n = 256, ARDS n = 139) out of scanned 1715 medical records. The survival rate of ECCO2R patients was 68% and significantly higher than 58% survival rate of controls (p = 0.025), with relative risk reduction (RRR) = 0.16, absolute risk reduction (ARR)= 0.10, number need to treat (NNT) = 10, and odds ratio (OR) = 1.5. In addition, iMV duration (12.8 +/- 2.6 vs. 17.1 +/- 4.9 days, p = 0.007) and LOS (16.9 +/- 4.1 vs. 18.9 +/- 5.5 days, p = 0.032) were significantly shorter than controls. Repeated measure analyses showed that LPV settings were successfully provided by 72 h of ECCO2R therapy. Subgroup analyses according to diagnoses of COPD and ARDS also favored ECCO2R. Conclusion: ECCO2R therapy significantly improved survival, iMV duration and LOS in patients with severe HRF due to COPD or ARDS, and successfully provided LPV approaches. Further studies are needed to assess promising benefits of ECCO2R therapy.Öğe The Levels and Duration of Sensory and Motor Blockades of Spinal Anesthesia in Obese Patients That Underwent Urological Operations in the Lithotomy Position(Hindawi Ltd, 2015) Ciftci, Taner; Kepekci, Ali Bestemi; Yavasca, Hatice Pjnar; Daskaya, Hayrettin; Inal, VolkanObesity has a significant effect on the cephalic spread of a spinal block (SB) due to a reduction in cerebrospinal fluid (CSF). SB is controlled by the tissue blood flow in addition to the CSF. Some positions and techniques of surgery used can cause changes in hemodynamics. We investigated effects of hemodynamic changes that may occur during Transurethral prostate resection (TURP) and lithotomy position (LP) at the SB level in obese versus nonobese individuals. Sixty patients who had undergone TUR-P operation under spinal anesthesia were divided into a nonobese (BMI < 25 kg/m(2), Group N) or obese (BMI >= 30 kg/m(2), GroupO) group. SB assessments were recorded afterthe LP. SB at 6 and 120 min and the peak SB level were compared between two groups. Hemodynamics were recorded after LP. Peak and 6 min SB levels were similar between the groups, while 120 min SB levels were significantly higher for Group O (P < 0.05). Blood pressure (BP) after the LP was significantly higher for Group N (P < 0.05). LP and TUR-P increased the BP in Group N when compared to Group O. The increase in hemodynamics enhances the blood flow in the spinal cord and may form similar SB levels in nonobese patients to those in obese patients. However, SB time may be longer in obese patients.Öğe A New Combination Therapy in Severe Acute Pancreatitis-Hyperbaric Oxygen Plus 3-Aminobenzamide An Experimental Study(Lippincott Williams & Wilkins, 2015) Inal, Volkan; Mas, Mehmet Refik; Isik, Ahmet Turan; Comert, Bilgin; Aydin, Sezai; Mas, Nukhet; Deveci, Mehmet SalihObjectives: This study was designed to evaluate effects of hyperbaric oxygen (HBO) plus 3-aminobenzamide (3-AB) cotreatment on tissue oxidative stress parameters (TOSp), tissue histopathology scores (THSc), and bacterial translocations (Bact-Trans) in an experimental model of severe acute pancreatitis (AP). Methods: Seventy-five Sprague-Dawley rats were randomized into 5 groups. Group 1 received sham. Severe AP was induced by intraductal taurocholate infusion and then group 2 received saline, group 3 received 3-AB, group 4 received 3-AB plus HBO, and group 5 received HBO. 3-Aminobenzamide (10 mg/kg per day, once daily, intraperitoneal) and saline (1 mL/kg) were started right after the induction, whereas HBO (2,8 atm pressure, BID, 90 minutes each) was started at the sixth hour. The rats were euthanized at the 54th hour, and TOSp, THSc, and Bact-Trans were studied. Results: In treatment groups 3 and 5, Bact-Trans (P < 0.05, P < 0.05), TOSp (P < 0.05, P < 0.05), and THSc (P < 0.001, P < 0.001) were significantly lower than controls. In addition to these findings, group 4 (cotreatment) showed the most significant effect on Bact-Trans and THSc (P < 0.001, P < 0.001) and also better in TOSp (P < 0.02). Conclusions: Poly(ADP-ribose) polymerase inhibition by 3-AB and HBO treatment alone was effective in the course of severe AP, and favorable with cotreatment because of the improved cascades of inflammatory process by different aspects.Öğe Pheochromocytoma presenting with rhabdomyolysis and acute renal failure: a case report(Informa Healthcare, 2014) Celik, Huseyin; Celik, Ozlem; Guldiken, Sibel; Inal, Volkan; Puyan, Fulya Oz; Tugrul, ArmaganRhabdomyolysis ranges from an asymptomatic illness with elevated creatine kinase levels to a life-threatening condition associated with extreme elevations in creatine kinase, electrolyte imbalances, acute renal failure, and disseminated intravascular coagulation. The most common causes are crush injury, overexertion, alcohol abuse, certain medicines, and toxic substances. A number of electrolyte abnormalities and endocrinopathies, including hypothyroidism, thyrotoxicosis, diabetic ketoacidosis, nonketotic hyperosmolar state, and hyperaldosteronism, cause rhabdomyolysis. Rhabdomyolysis and acute renal failure are unusual manifestations of pheochromocytoma. There are a few case reports with pheochromocytoma presenting rhabdomyolysis and acute renal failure. Herein, we report a case with pheochromocytoma crisis presenting with rhabdomyolysis and acute renal failure.Öğe Predictive ability of shock index in survival of ICU admitted emergency surgery patients: A retrospective cohort study(Turkish Assoc Trauma Emergency Surgery, 2022) Inal, Volkan; Efe, Serdar; Ademoglu, ZelihaBACKGROUND: Shock index (SI) is defined as the ratio of heart rate to systolic blood pressure and is a feasible and reliable tool to assess patients' circulatory status in emergency conditions. Its efficiency was shown in hemorrhagic shock, sepsis, trauma, and emergency triages. This study was planned to evaluate predictive ability of SI on 28-day survival of intensive care unit (ICU) admitted emergency surgery (eSurg) patients. METHODS: The study was conducted in a 20-bed capacity ICU of a University Hospital. Medical records of patients who were admitted to ICU after an eSurg between January 1, 2017, and December 31, 2019, were retrospectively scanned. Patients with age <18 and >90, elective surgeries, no written consents, missing data, and lost to follow-up were excluded from the study. Patients age, gender, surgery type, associated medical comorbidity, ICU mechanic ventilatory (MV) length, length of stay (LOS), and 28-day survival status were recorded. Selected pre-operative (pre-op) and post-operative (post-op) laboratory parameters (hemoglobin [Hb], platelet count, international normalized ratio [INR], and pH) were collected, sequential organ failure assessment and SI scores were calculated. Data were statistically processed with 95% confidence interval and p<0.05 significance in relation to survival. RESULTS: Patient survival rate was 95%. Abdominal and gastrointestinal surgeries constituted 47% of the cases. The most frequent comorbidities were cardiovascular and pulmonary diseases. In statistical analyses, neither surgery type nor associated medical con-dition was related to patient outcome. The mean LOS was 2.3 days. The mean MV length was about 23 h and significantly shorter in survived patients (p<0.001, t=-7.5). The higher post-op Hb levels were related to the higher survival (p=0.020, t=2.4). Post-op higher INR levels were found as a negative prognostic factor for survival (p=0.025, t=-2.3). Both pre-op and post-op pH levels were significantly related to patient survival (p=0.001, t=1.9 and p<0.001, t=7.1). The lower post-op SI scores were predictive to the shorter MV lengths (p=0.010, t=1.9). A significant relation was presented between lower pre-op and especially post-op SI scores and patients' survival (p=0.001, t=-1.6 and p=0.001, t=-2.9). CONCLUSION: This study presented that SI scores successfully predicted patients' survival in ICU admitted eSurg patients. We believe that the SI forgotten in the dusty shelves of the literature does not get the importance it deserves. SI is a simplistic, reliable, and highly cost-effective assessment tool. Larger prospective RCTs should be planned to assess feasibility and reliability of SI in different patient populations.Öğe Prognostic Significance of Critical Patients' Platelet Indexes in Mixed Type Critical Care Unit(Turkish Soc Medical & Surgical Intensive Care Medicine, 2019) Efe, Serdar; Asker, Ismail; Inal, VolkanIntroduction: Thrombocyte indexes (TIN) are biological markers of thrombocyte morphology and function. In critical patients, few studies evaluated TIN relation with disease severity and prognosis. Aim: In this study, we objected to evaluate TIN as a routine feasible parameter at respect of clinical significance to predicting mortality, even though thrombocyte count and functions were prone to alter by variable conditions of critical care unit patients. Materials and methods: Data of 314 patients those with objected parameters out of 347 retrospectively evaluated for TIN relation with clinical surveillance and demographics, in a ten bed capacity mixed-type tertiary CCU in between Jan 1st - 31st Dec 2016. Results: Patients', 194 male (62%), mean age was 62.7 +/- 16.9 (19-86) and APACHE II score was 18.9 +/- 8.5, mean length of stay (LOS) was 9.1 (1-182) days and with 43% mortality. The mean thrombocyte volume (MPV) and dispersion width (PDW) indexes were both correlated each other and positively with disease severity, on the other hand negatively with thrombocyte count. The higher plateletcrit (PCT) levels otherwise lower MPV and PDW were found in males, and also showed relatively lower mortality rates (37.6%<44.1%) (p<0.01). Increrased PDW levels and lower thrombocyte counts were related to higher mortality, in addition to this, PCT<0.17 levels showed 2x higher mortality risk compared to PCT>0.32. Both PDW/PLT and PDW/PCT ratios related to mortality too (p<0.001, p<0.001), otherwise with relatively lower coefficients (r: 0,11, r: 0,10). Conclusion: TIN in mixed type CCUs was assumed as PDW and PCT could be included to disease severity scoring system prognostic biomarkers, like thrombocyte counts.Öğe A Retrospective Analysis of Quality Indicators in a Mixed-type Tertiary Center Intensive Care Unit(Turkish Soc Medical & Surgical Intensive Care Medicine, 2018) Efe, Serdar; Sak, Istiklal; Inal, VolkanObjective: We aimed to take a snapshot to assess critical care specific quality indicators and performance of our critical care patients' management course and to have some clues to improve our total quality as the first step of the Total Quality Management course. Material and Methods: The demographic and clinical data of 347 patients admitted to our tertiary center 10-bed mixed-type critical care unit between Jan 1, 2016 and Dec 31, 2016 were retrospectively analyzed at respect of designated quality indicators, herein by Pabon Lasso's Method. Results: The patients' mean age was 65 +/- 16 years, average LOS was 8.9 +/- 16 days, bed turnover rate was 34.7, occupancy rate was 98.3%, mean APACHE II score was 23 +/- 9, and standardized mortality rate was < 1 (0.97). The readmission rate after 48 h of discharge was 2.6%. The post-discharge 90-day mortality rate was 5.1%, post-operative 48th h mortality rate was 2.2%, central venous catheter rate (CVC) was 82%, CVC related blood stream infections were 12.7%, invasive mechanic ventilator (IMV) rate was 71%, IMV-days was 6.5 +/- 3 days, and VAP rate was 12.7%. Conclusion: The common quality indicators are not assumed and are objected to compare the inter-ICUs' differences, on the other hand, could provide useful information about deficient or inefficient points of data to improvable clinics' own performance.Öğe Rox Index Dynamics According to High Flow Nasal Cannula Success in Intensive Care Unit Patients with COVID-19-Related Acute Respiratory Failure(Galenos Publ House, 2023) Hancl, Pervin; Uysal, Ahmet; Yuksel, Beyza; Inal, VolkanBackground: High-flow nasal cannula therapy has been shown to be useful in the treatment of patients with acute respiratory failure caused by severe acute respiratory syndrome-coronavirus disease-2. The ROX index can help predict the success of high-flow nasal cannula in coronavirus disease-19-related acute respiratory failure. However, the timing of ROX-index assessment is still unclear to protect the patients from complications due to early or delayed intubation.Aims: To evaluate the relation between ROX index patterns within the first 48 hours of the therapy and high-flow nasal cannula success rates. The secondary aim was to determine other possible predictors of high -flow nasal cannula failure.Study design: A cross-sectional study.Methods: Patients admitted to the intensive care unit between April 2020 and January 2022 with coronavirus disease-19-related acute respiratory failure and treated with high-flow nasal cannula were included in the study. Patients' demographics, clinical characteristics and laboratory findings at intensive care unit admission; ROX indices at initiation, 2nd, 8th, 12th, 24th and 48th hours of high-flow nasal cannula; and outcomes were recorded.Results: In the study period, 69th patients were managed with high -flow nasal cannula for at least 2 hours. While 24 patients (34.7%) were successfully weaned from high-flow nasal cannula, 45 (65.3%) patients failed. Overall mortality at day 28 was 44.9%. ROX indices were lower in the high-flow nasal cannula failure group through the 12th, 24th, and 48th hours of the therapy, no significant change was observed (P = 0.33). While an overall increase in ROX index patterns were detected in patients weaned from high-flow nasal cannula (P = 0.002). Pairwise analyses revealed that ROX indexes remain stable during the first 8th hours in both groups, then improved to 12th hours of the therapy in successfully high-flow nasal cannula-weaned patients.Conclusion: Dynamic assessments of the ROX indexes could be more suggestive rather than a point assessment to identify patients who would benefit from the high-flow nasal cannula or deteriorate in coronavirus disease-19 related acute respiratory failure.
