Yahya Kemal Günaydın

Background and Objectives: The interaction between the brain and heart has become more interesting in the last 20 years. The most common cardiac complications after stroke are myocardial infarction, heart failure, arrhythmias, electrocardiographic disturbances, repolarization disorders, and sudden cardiac death. The prolonged Tpeak–Tend interval is an indicator of the electrical heterogeneity of the myocardium (abnormal repolarization) that causes malignant arrhythmias. We aimed to investigate whether the Tpeak–Tend interval, which reflects the heterogeneity of repolarization, is prolonged in stroke and its relationship with short-term mortality. Materials and Methods: Individuals over the age of 18 who presented with hemorrhagic or ischemic stroke were included in the study. Demographic characteristics, laboratory and imaging findings of the patients were recorded. ECGs were obtained at the time of admission to the hospital and 24 h later. Patients were followed for in-hospital mortality. Results: 89 (82.4%) of the patients had ischemic stroke, 19 (17.6%) had hemorrhagic stroke. It was determined that Tp-eV2 and Tp-eV5 at hospital admission were significantly longer than the 24th hour values. A total of 92.01 (16.3) ms at Tp-eV2 admission, 84.1 (16.3) ms after 24 h (p = 0.003), 91.9 (7.3) msTp-eV5 at admission, and 81.6 (17.8) ms (p = 0.000) after 24 h. In multivariate logistic regression analysis of in-hospital mortality, Tp-eV2 (HR: 0.96 (95% CI 0.93–0.99) p = 0.008) was determined as an independent predictor among cardiovascular parameters. Conclusions: Tp-e intervals were prolonged in both leads V2 and V5 in patients with stroke. Prolongation of lead V2 in the Tp-e interval is an independent indicator of short-term mortality among cardiovascular parameters.

Target Temperature Management (TTM) is a procedure used in post-cardiac arrest (CA) patients to reduce mortality and morbidity. The goal of this study was to investigate the link between intracrani...

Background In this study, we aimed to evaluate the role of the glucose-to-potassium ratio in predicting in-hospital mortality and prognosis of patients diagnosed with sepsis and septic shock in an emergency department and admitted to an emergency critical intensive care unit (ICU). Methods This study was a retrospective and observational evaluation of nontraumatic sepsis and septic shock patients > 18 years of age who were admitted to the emergency department of a tertiary training and research hospital and had available glucose and potassium values at the time of admission. The patients were evaluated over a 24-month period. The primary goal of this study was to examine the relationship between the glucose-to-potassium ratio and in-hospital mortality in sepsis patients. Results Data derived from 175 patients were included in the statistical analysis. Blood urea nitrogen, creatinine, lactate dehydrogenase, direct bilirubin, C‑reactive protein, and lactate levels were found to be significantly higher in the nonsurvivor group than in the survivor group (p < 0.05). On the other hand, hemoglobin, hematocrit, albumin, pH, HCO₃ and base excess levels were found to be statistically significantly higher in the survivor group than in the nonsurvivor group (p < 0.05). The glucose-to-potassium ratio was not significant in terms of predicting mortality in sepsis patients (p = 0.324). In the receiver–operating characteristic (ROC) analysis of various parameters’ significance in terms of predicting mortality, APACHE 2 scores had the highest area under the curve (AUC) value (0.729). Conclusion According to the results of this study, the glucose-to-potassium ratio did not have a significant value in predicting mortality risk in sepsis and septic shock patients admitted from the emergency department to the emergency critical ICU.

Angioedema describes a non-dependent, non-pitting and transient edema caused by the accumulation of vasoactive substances in the circulation. These vasoactive substances increase vascular permeability, causing swelling of the deep dermal, submucosal or subcutaneous tissues of the face, lips, neck, extremities or gastrointestinal tract. Urticaria may or may not accompany this condition. Angioedema is generally mediated through two pathways: histamine-mediated and bradykinin-mediated. Histamine-mediated angioedema generally responds to standard therapeutic measures (such as antihistamines, steroids and epinephrine), whereas bradykinin-mediated angioedema can be more difficult to manage in emergency departments (ED). Here, we present a patient who presented to our ED with bradykinin-mediated ACE-I-associated dramatic angioedema clinic, did not respond to standard treatments, rapidly improved with fresh frozen plasma (FFP) administration and was discharged after 6 days of follow-up in the emergency critical intensive care unit.

As this is a letter to the editor, there is no abstract section.

Aims: In our study, we aimed to compare the codes white given by the emergency services of two tertiary hospitals in Ankara, to reveal the significant differences between them and to discuss the reasons that may lead to these differences. Methods: In our study, we compared the codes white data given from the Emergency Medicine Department of Bilkent Ankara City Hospital (ABCH) and Ankara Training and Research Hospital (ATRH) between 01.01.2021 and 31.12.2022. We classified the data according to the gender, occupation, working hours of the violence, the person who caused the violence, and the type of violence. For research analysis, we grouped the data using Windows-based Microsoft 365 Excel, and for statistical analysis, we used IBM SPSS version 26. Results: The gender that was exposed to violence more in ABCH was women, the most frequent perpetrators were the relatives of the patients, and the type of violence experienced was verbal violence. In ATRH, male health workers were the most frequently exposed to violence, while the most frequent perpetrator was the patient himself, and more cases of physical violence were reported. Conclusion: There are significant differences between the incidents of violence in the emergency departments of the two hospitals, which have different socio-cultural environments due to their location.

Background Recent studies have analyzed the qSOFA (quick sequential organ failure assessment) score as a prognostic indicator in many diseases, particularly sepsis. However, the effect of qSOFA score on prognosis and mortality in critical care patients has not been sufficiently analyzed. There is not enough data, especially regarding its use as critical care mortality and prognosis scoring. In this study, we aimed to analyze the effect of qSOFA score on mortality and prognosis in critical care unit (CCU) patients.Methods This study was conducted retrospectively using the chart review method. The APACHE II (Acute Physiology and Chronic Health Evaluation II) and SOFA (Sequential Organ Failure Assessment) scores of patients admitted to our CCU were compared with the qSOFA score. In addition, the need for intubation and mechanical ventilation, short- and long term mortality rates, the relationship between blood gas lactate values and qSOFA score were analyzed.Results A total of 1816 patients were included in the study. During critical care follow-up, 374 (20.6%) of our patients died, and at the end of 6 months, 796 (43.8%) of our patients died. A statistically significant association was found between in-hospital mortality and qSOFA, SOFA scores and lactate levels (P = 0.001, P = 0.001, P = 0.01 respectively). A statistically significant association was found between 6-month mortality and SOFA score only. (P = 0.001) The SOFA score appeared to be the most successful predictor of mortality. The cut-off for mortality using the ROC curve was ≥ 7 [sensitivity 78.1%; specificity 85.9%; AUC 0.91; 95% confidence interval (CI), 0.89 to 0.92; P = 0.001]. qSOFA scoring also performed well. The cut-off value for mortality using the ROC curve was ≥ 2 (sensitivity 42.5%; specificity 93.9%; AUC 0.83;95% CI, 0.80-0.85; P = 0.001).Conclusion We believe that the qSOFA score can be used as a marker for in-hospital mortality and prognosis in critical care patients. Especially in cases where the qSOFA score is ≥ 2, it provides valuable information regarding mortality and prognosis.

Amaç: Bu çalışmada, acil servise başvuran Coronavirus Disease 2019 pnömonisi olan hastalarda Presepsin (PSP)’in prognostik önemini araştırmayı amaçladık. Materyal ve Metotlar: Bu çalışma, prospektif, vaka-kontrollü, gözlemsel bir çalışma olarak yapılmıştır. Covid-19 pnömonisi tanısı konulan 123 hasta vaka grubu olarak seçilmiş ve 123 gönüllü de kontrol grubu olarak çalışmaya alınmışlardır. Hastaların 62'si sepsis grubuna, 61'i ise sepsis olmayan grup olarak sınıflandırılmıştır. Hastaların takibi ve tedavisi, Türkiye Sağlık Bakanlığı Covid-19 Ciddi Pnömoni, ARDS, Sepsis ve Septik Şok Yönetim Kılavuzu'na göre yapılmıştır. PSP düzeyi, Covid-19 pnömonisi tanısı konulan hastalarda sepsisli ve sepsisli olmayanlar arasında incelenmiştir. Bulgular: PSP değerleri karşılaştırıldığında, kontrol grubu, sepsis grubu ve sepsis olmayan grup arasında istatistiksel olarak anlamlı farklılık bulunmamıştır. Ancak vaka grubu için ROC eğrisi incelendiğinde, sağ kalanlar ve sağ kalmayanlar arasında istatistiksel olarak anlamlı fark saptanmıştır (p<0,05). Sonuç: Covid-19 pnömonisi olan hastalarda kontrol grubu ile sepsis ve sepsis olmayan hasta grupları arasında PSP değerleri arasında istatistiksel olarak anlamlı fark bulunmamıştır. Ancak PSP değerleri, Covid-19 pnömonisi mortalitesi ve sağ kalımında istatistiksel olarak anlamlı bulunmuştur.