Ramazan Kargin

Objective : The Systemic inflammation response index (SIRI) is a novel inflammatory marker. This study aims to evaluate the association between early postoperative SIRI and a prolonged intensive care unit (ICU) stay exceeding 24 hours after brain tumor (BT) surgery.Methods : Patients aged 18 years or older who were admitted to the ICU following elective BT surgery between January 2023 and December 2024 were analyzed. Preoperative and postoperative variables were compared between patients with a short ICU stay (<24 hours) and those with a prolonged ICU stay. Logistic regression analyses were performed to evaluate the association between perioperative variables, including early postoperative SIRI, and prolonged ICU stay. Receiver operating characteristic (ROC) curve analysis, along with area under the curve (AUC) and Youden index, was conducted to assess the discriminatory performance of early postoperative SIRI.Results : A total of 206 patients who were admitted to the ICU following elective BT surgery were included in the study. One hundred nine patients were classified as having an ICU length of stay less than 24 hours, whereas 97 patients were classified as having an ICU length of stay exceeding 24 hours. In multivariable logistic regression analyses, hypertension (odds ratio [OR], 4.365; 95% confidence interval (CI), 1.903–10.010; p=0.001), postoperative SIRI level (OR, 1.090; 95% CI, 1.041–1.142; p<0.001), hemorrhage (OR, 14.348; 95% CI, 1.663–123.812; p=0.015), cerebral edema (OR, 5.972; 95% CI, 1.076–33.148; p=0.041) and neurological deficit (OR, 2.582; 95% CI, 1.072–12.149; p=0.032) were independently associated with prolonged ICU stay following BT surgery. Using prolonged ICU stay as the endpoint, ROC analysis identified an optimal SIRI cut-off value of 10.94, with a sensitivity of 56.7%, specificity of 81.7%, and an AUC of 0.728.Conclusion : Given the clinical importance of optimizing ICU resource utilization, early postoperative SIRI may provide adjunctive information reflecting postoperative inflammatory response associated with prolonged ICU stay, particularly when interpreted with other clinical parameters.

Background: Low-flow, low-gradient aortic stenosis with reduced left ventricular ejection fraction is a heterogeneous condition with challenging severity assessment. Aortic valve calcification reflects fibro-calcific remodeling, while oxidative stress plays a key role in its pathogenesis. Serum uric acid, a marker of oxidative stress, may be associated with valvular calcification. This study investigated the relationship between serum uric acid levels and aortic valve calcification in this population. Methods: This retrospective study included 85 patients. Aortic valve calcification was quantified using computed tomography with the Agatston method, and patients were categorized as true severe or pseudo-severe according to sex-specific calcium thresholds. Of the patients, 57 were classified as true severe and 28 as pseudo-severe aortic stenosis. Results: Patients with higher calcification burden had significantly elevated serum uric acid levels (6.77 ± 1.57 vs. 5.08 ± 1.10 mg/dL, p < 0.001). Serum uric acid showed a modest correlation with aortic valve calcium score (ρ = 0.339, p = 0.002) and remained independently associated with CT-defined true severe low-flow, low-gradient aortic stenosis in multivariable analysis. ROC analysis yielded an area under the curve of 0.823 and identified a serum uric acid threshold of 5.45 mg/dL associated with a greater likelihood of CT-defined true severe low-flow, low-gradient aortic stenosis. Conclusions: Serum uric acid is associated with CT-derived aortic valve calcification and may provide insight into underlying fibro-calcific remodeling in this population.

Background: Although transcatheter aortic valve implantation (TAVI) outcomes are well-documented, predictors of mortality beyond conventional surgical risk scores and valve-related factors in real-world, high-risk cohorts require further elucidation. This study aimed to identify the key determinants of 30-day and 1-year mortality following TAVI, with a focus on both patient-specific and procedure-specific complications. Methods: The KOSUTAVI study is a single-center, retrospective cohort analysis of 859 consecutive high-risk individuals with severe aortic stenosis undergoing TAVI between 2020 and 2025. Primary endpoints were 30-day and 1-year all-cause mortality. Multivariate Cox regression and Kaplan–Meier analyses were used to identify independent risk factors. Results: Mean age was 78.7 ± 6.5 years, and mean Society of Thoracic Surgeons score was 7.4 ± 2.2. The 30-day and 1-year mortality rates were 6.5% (n = 56) and 12.4% (n = 107), respectively. The 5-year all-cause mortality rate was 26.3%. In multiple Cox’s analysis, chronic renal failure (hazard ratio [HR] = 7.75, P = .008, 95% CI = 1.29-16.54), presentation with cardiogenic shock (HR = 5.83, P = .028, 95% CI = 1.19-15.41), major vascular injury (HR = 22.7, P = .019, 95% CI = 1.89-45.91), and cardiac tamponade (HR = 17.9, P = .012, 95% CI = 8.13-52.62) were independently associated with 30-day mortality. While these factors were all significant in univariate analysis for 1-year mortality, they did not retain independence in the multiple model. Valve type, access route, and sex were not associated with increased mortality. Conclusion: In a high-risk TAVI population, early mortality is predominantly driven by pre-existing renal dysfunction and acute procedural complications (shock, vascular injury, and tamponade), rather than valve-specific factors. These findings underscore the critical importance of optimizing renal function before the procedure and implementing advanced vascular protection strategies to improve early survival after TAVI.

Objectives: Inflammation plays a very important role in the pathogenesis of coronary artery disease (CAD) and its prognosis. Especially; C-reactive protein (CRP) is associated with poor prognosis in patients with CAD. In this study, the relationship between CRP levels and body mass ındex (BMI) was investigated in patients who underwent primary coronary intervention (PCI) due to ST elevation myocardial infarction (STEMI). Methods: Between January 2015 and February 2016, 132 patients who underwent PCI due to acute STEMI were included in the retrospective study. Patients were classified into two groups: (Group 1: BMI 35 kg/m² n=9, total: 36 patients; Group 2: 25 2 n=58 and 30 <BMI BMI <35. Whereas, it was significantly higher in STEMI patients with 25 35. One of the reasons for the better prognosis of mildly overweight and Class 1 obese patients with STEMI diagnosis may be the low values of CRP which has many effects on atherosclerotic plaque formation.

Tr en Amaç: Çocukluk ve ergenlikte yüksek morbidite ve mortaliteye sahip miyokardit patogenezi tam olarak aydınlatılamamıştır. Akut miyokardit patogenezi, çoklu ajanların rol oynadığı karmaşık bir süreçtir. Miyokarditin akut alevlenmesi ve klinik remisyon sırasında EKG, laboratuvar ve ekokardiyografik parametreleri karşılaştırmayı amaçladık. Materyal ve Yöntem: Akut miyokardit atağı olan 144 hasta (124 erkek, 20 kadın) çalışmaya dahil edildi (28 ± 5). Bu hastalar 3-12 aylık klinik remisyon döneminde kontrol altına alındı. Akut alevlenme ve klinik remisyon sırasında hastaların EKG, laboratuvar ve ekokardiyografik parametreleri karşılaştırıldı. QT ve Tp-e gibi EKG parametreleri ölçüldü. Rutin biyokimya ve hemogram parametrelerine ek olarak troponin I, ürik asit, CRP, sedimantasyon, TSH ve kolesterol düzeyleri ölçüldü. Sol ventrikül ejeksiyon fraksiyonu ekokardiyografik parametre olarak ölçüldü. Bulgular: Klinik remisyon ile karşılaştırıldığında, akut atak miyokarditli hastalarda Tp-e aralığı (p: 0,032), QT-max (p = 0,014), QT-min (p = 0,001), TSH (p <0,001), Trop (p <0,00), Üre (p = 0,028), Alt (p = 0,010), Ast (p <0,001), Wbc (p <0,001), Hb (p <0,001), Htc (p <0,001), Rdw (p <0,001), Plt (p <0,001), Mpv (p <0,001), Neu (p = 0,003), Lym (p = 0,013), Mon (p <0,001), Eo (p = 0,003), Pdw (p <0,001), CRP (p=0,001), ESR (p<0,001), and HDL-C (p=0,002) önemli ölçüde değişmiştir. Sonuç: EKG parametreleri, inflamasyon belirteçleri ve HDL kolesterol düzeyleri, hastaların akut alevlenmesi sırasında sol ventrikül ejeksiyon fraksiyonuna ek olarak klinik remisyonda önemli ölçüde iyileşti. LVEF, EKG parametreleri, inflamasyon belirteçleri, TSH ve HDL kolesterol düzeylerinin hastalığın klinik seyri ve patogenezi açısından önemli olduğu düşünülmektedir. Aim: The pathogenesis of myocarditis, which has high morbidity and mortality in childhood and adolescence, has not been fully elucidated. The pathogenesis of acute myocarditis is a complex process in which multiple agents play a role. We aimed to compare ECG, laboratory and echocardiographic parameters of patients during acute exacerbation of myocarditis and clinical remission. Material and Method: 144 patients (124 males, 20 females) with an acute myocarditis episode were included in the study (28 ± 5). These patients were called for control during the clinical remission period of 3-12 months. The ECG, laboratory and echocardiographic parameters of the patients were compared during acute exacerbation and clinical remission. QT and Tp-e ECG parameters were measured. In addition to routine biochemistry and hemogram parameters, troponin I, uric acid, CRP, sedimentation, TSH and cholesterol levels were measured. Left ventricular ejection fraction was measured as an echocardiographic parameter. Results: When compared with the clinical remission Tp-e interval (p: 0.032), QT-max (p=0.014), QT-min (p=0.001), TSH (p<0.001), Trop (p<0.00), Urea (p=0.028), Alt (p=0.010), Ast (p<0.001), Wbc (p<0.001), Hb (p<0.001), Htc (p<0.001), Rdw (p<0.001), Plt (p<0.001), Mpv (p<0.001), Neu (p=0.003), Lym (p=0.013), Mon (p<0.001), Eo (p=0.003), Pdw (p<0.001), CRP (p=0.001), ESR (p<0.001), and HDL-C (p=0.002) were significantly changed in patients with acute attack myocarditis. Conclusion: ECG parameters, inflammation markers, and HDL cholesterol levels were significantly improved in the clinical remission in addition to the left ventricular ejection fraction during acute exacerbation of the patients. LVEF, ECG parameters, inflammation markers, TSH and HDL cholesterol levels were thought to be important in terms of clinical course and pathogenesis of the disease.

Background: The aim of this study was to explore the role of oxidative stress index (OSI), myeloperoxidase (MPO), and catalase (CAT) activity in cardiac allograft vasculopathy (CAV) in heart transplant recipients (HTRs).Methods: The study enrolled a median age of 41 ± 9 years 47 recipients. The HTx patients were divided into two groups based on the presence CAV as follows: CAV⁽⁺⁾ and CAV⁽⁻⁾ group. Also, CAV⁽⁺⁾ group were divided into two groups as mild/moderate to severe CAV. The OSI, MPO, and CAT activity were analyzed in both groups.Results: The mean total antioxidant capacity (0.79 ± 0.46 vs 1.03 ± 0.33 μmol H₂O₂ equiv/L) P = .043 was significantly lower and OSI, MPO, CAT activity were significantly higher in CAV⁽⁺⁾ group (63 ± 38 vs 20 ± 16 arbitrary unit, P = .001; 398 ± 242 vs 139 ± 112 μg/L, P = .001; 51 ± 42 vs 26 ± 23 pmol/mg protein, P = .013, respectively). Also, mean OSI (38 ± 41 vs 93 ± 75, P = .05) were significantly higher in severe CAV⁽⁺⁾ group. Recipient age, male gender, and low density lipoprotein‐cholesterol were significantly higher in CAV⁽⁺⁾group. There was a moderate correlation between the CAV grade and OSI, MPO, and CAT levels in univariate analysis (r = .560, P = .002; r = .643, P = .007; r = .681, P = .001, respectively).Conclusion: An increase in the serum level of OSI, MPO, and CAT was associated with CAV in HTRs.

The safety of beta-blockers as a heart rate-limiting drug (HRLD) in patients with acute respiratory failure (ARF) due to chronic obstructive lung disease (COPD) has not been properly assessed in the intensive care unit (ICU) setting. This study aims to compare the use of beta-blocker drugs relative to non-beta-blocker ones in COPD patients with ARF due to heart rate-limiting with respect to length of ICU stay and mortality.

The concurrence of acute coronary syndrome with allergy or hypersensitivity as well as with anaphylactic or anaphylactoid reactions is increasingly encountered in daily clinical practice. There are several reports associating mast cell activation with acute cardiovascular events in adults. This was first described by Kounis as 'allergic angina syndrome',progressing to 'allergic myocardial infarction'. The main mechanism proposed is the vasospasm of coronary arteries. We present a case of a 28-year-old man who was admitted to our hospital with thoracic pain and dyspnoea. The symptoms recurred after simultaneous use of 1 g amoxicillin/clavulanic acid orally and 1 g ampicillin/sulbactam parenterally for tonsillitis the night before presentation and on the morning of admission.

Background: Sleep deprivation (SD) is known to be associated with an increased incidence of adverse cardiovascular outcome. Atrial electromechanical delay (AEMD) calculated from tissue Doppler imaging has been shown to detect atrial impairment in paroxysmal atrial fibrillation. The aim of the study was to investigate whether AEMD would increase in otherwise healthy young adults with acute SD. Methods: Twenty‐seven healthy volunteers were included into the study (mean age: 26 ± 3 years). The participants underwent an echocardiographic examination after a night with SD. AEMD defined as the interval from the onset of P wave to the onset of late diastolic Am wave (PA) was calculated from the lateral and septal mitral annulus, and lateral tricuspid annulus (PA lateral, PA septum, and PA tricuspid, respectively). Results: Subjects had similar values of PA tricuspid duration in milliseconds after the night of sleep debt when compared after regular sleep, whereas they had significantly higher values of PA lateral and PA septal durations (69.05 ± 10.64 ms vs 51.31 ± 11.32 ms, P < 0.001 and 51.75 ± 7.15 ms vs 41.37 ± 8.52 ms, P < 0.001; respectively). Moreover, participants had higher inter‐AEMD and intra‐AEMD values after the night of sleep debt when compared after regular sleep [30.19 ± 9.84 ms vs 14.72 ± 6.81 ms, P < 0.001 and 12.82 ± 7.09 ms vs 4.41 ± 3.60 ms, P < 0.001; respectively]. Pearson's correlation analyses suggest that inter‐AEMD and intra‐AEMD were inversely correlated with sleep time (r =−0.628, r =−0.499, r =−0.696, and r =−0.572, respectively [all P < 0.001]). Conclusion: In conclusion, in this cross‐sectional study, we clearly found that even one night of SD is associated with higher values of inter‐AEMD and intra‐AEMD in healthy young adults. (PACE 2011; 34:1645–1651)