Onur Avcı

Objective: The Pan-Immune-Inflammation Value (PIV) has recently emerged as a promising inflammation-based biomarker in several malignant and inflammatory diseases. However, its prognostic significance in Crimean-Congo hemorrhagic fever (CCHF) has not previously been investigated. This study evaluated the prognostic value of admission PIV in critically ill patients with CCHF and compared its performance with established disease-specific severity scores and other inflammatory biomarkers.Methods: This retrospective observational cohort study included 110 adult patients with laboratory-confirmed CCHF admitted to the intensive care unit of a tertiary referral hospital between 2014 and 2025. Admission PIV, Systemic Immune-Inflammation Index (SII), Systemic Inflammation Response Index (SIRI), fibrinogen-to-albumin ratio (FAR), and Severity Grading Score (SGS) were evaluated. Receiver operating characteristic (ROC) analysis, Spearman correlation, Kaplan–Meier survival analysis, and multivariable logistic regression were performed to assess their association with in-hospital mortality.Results: PIV showed poor discriminatory ability for predicting in-hospital mortality (AUC=0.508) and was not independently associated with mortality in multivariable analysis (OR=1.199, 95% CI 0.80–1.79; p=0.373). In contrast, SGS demonstrated the highest predictive performance (AUC=0.739) and remained the only independent predictor of mortality (OR=1.382, 95% CI 1.11–1.71; p=0.003). FAR showed high sensitivity (91.7%) but limited specificity (40.0%). PIV correlated significantly with APACHE II, SIRI, SII, blood urea nitrogen, creatinine, and SGS but not with SOFA.Conclusion: Admission PIV has limited prognostic utility in critically ill patients with CCHF and does not provide incremental prognostic value beyond established disease-specific severity scores. SGS remains the most reliable predictor of mortality in this patient population.

Purpose: Effective postoperative pain management is essential following laparoscopic appendectomy. This exploratory pilot randomized controlled trial aimed to compare the postoperative analgesic efficacy of the transversus abdominis plane (TAP) block and the modified thoracoabdominal nerve block through the perichondrial approach (M-TAPA) in patients undergoing laparoscopic appendectomy. Patients and Methods: This prospective, double-blind, single-center exploratory pilot randomized controlled trial included 30 adult patients (ASA I–III) scheduled for laparoscopic appendectomy due to uncomplicated acute appendicitis. Patients were randomly allocated to receive either bilateral TAP block (Group T, n = 15) or bilateral M-TAPA block (Group M, n = 15) under ultrasound guidance following induction of general anesthesia. Both groups received standardized multimodal analgesia. Postoperative pain intensity assessed by Numeric Rating Scale (NRS) was the primary outcome. Secondary outcomes included 24-hour tramadol consumption, Quality of Recovery-15 (QoR-15) scores, and adverse events. Pain assessments were performed at 1, 6, 12, 18, and 24 hours postoperatively by a blinded assessor. Results: All randomized patients completed the study. Demographic and clinical characteristics did not differ significantly between groups. Resting and dynamic NRS scores did not differ significantly between the TAP and M-TAPA groups at any postoperative time point (all p > 0.05). Median 24-hour tramadol consumption was 50 mg (0– 50) in both groups. No statistically significant difference was detected in QoR-15 scores between groups (p = 0.51). No block-related complications or opioid-related adverse effects were observed. Conclusion: In this exploratory pilot randomized controlled trial, M-TAPA did not demonstrate superiority over the TAP block with respect to postoperative pain intensity, opioid consumption, or quality of recovery following laparoscopic appendectomy. Within a standardized multimodal analgesia regimen, both techniques were associated with low pain scores and minimal opioid requirements. Larger, adequately powered randomized trials are warranted to confirm these preliminary findings.

Objective: This study aimed to investigate whether lung mechanics were affected in patients recovering from Covid-19 without ARDS who did not undergo lung imaging during the active infection period. Methods: The study included pregnant patients undergoing cesarean section operations. Participants were divided into two groups: those who had recovered from Covid-19 within the past year (group 1, n=50) and those who had never been infected with Covid-19 (group 2, n=50). The study included 100 patients divided into two groups: those who had recovered from Covid-19 within the last year (group 1, n=50) and those who had never experienced Covid-19 infection (group 2, n=50). Peak pressure (Ppeak), plateau pressure (Pplato), dynamic compliance (Cdyn), and positive end-expiratory pressure (PEEP) values, measured by the anesthesia machine, were recorded at specified time intervals following intubation. Results: Comparisons of Ppeak, Pplato, ΔP, Cdyn, and R data at specified times (1 min, 5 min, 10 min, 20 min, 30 min, and 40 min) showed no significant differences between the groups (p>0.05). Conclusion: No significant differences in lung mechanics were found between the Covid-19-recovered patient group and the control group. Differences observed in SpO2, MAP, and Cdyn values in both groups are considered to be expected changes associated with routine procedures of general anesthesia

Postherpetic neuralgia results from varicella-zoster virus reactivation post–chickenpox infection, manifesting as persistent and severe pain lasting a minimum of 3-mo post–herpes zoster onset. Traditional postherpetic neuralgia management comprises antiviral, analgesic medications, corticosteroids, and various agents. Ultrasound-guided nerve blocks have recently emerged as a promising postherpetic neuralgia treatment. In a case involving a 58-year-old man with severe thoracic herpes zoster lesions, the serratus posterior superior intercostal plane block was employed under ultrasound guidance, significantly reducing pain scores and enhancing quality of recovery. This study underscores serratus posterior superior intercostal plane block’s secure, effective role in managing thoracic herpes zoster, and mitigating postherpetic neuralgia risk. This case report represents the pioneering application of serratus posterior superior intercostal plane block for postherpetic neuralgia, offering a promising avenue for relieving patients suffering from this condition.

Background and Aims: Serratus posterior superior intercostal plane block (SPSIPB) is a novel technique that can provide analgesia in the hemithorax, shoulder, and back of the neck. This study aimed to evaluate the post-operative analgesic effect of SPSIPB in patients undergoing video-assisted thoracoscopic surgery (VATS). Methods: It is a double-blind, randomised controlled trial. Twenty-four adult patients who underwent VATS via the uniportal technique were randomised into two groups: the SPSIPB group (n = 12) received SPSIPB along with intravenous patient-controlled analgesia (PCA) with tramadol, whereas the control group (n = 12) received only PCA with tramadol. At the end of the surgery, patients in the SPSIPB group received a unilateral SPSIPB under ultrasound guidance with the use of 30-mL bupivacaine 0.25%. The primary outcome was the numerical rating scale (NRS) scores of the patients. Secondary outcomes included the amount of tramadol and rescue analgesic (paracetamol) consumed by the patients, followed up for post-operative 24 hours. Categorical variables were compared using the Chi-Square Test. Mann–Whitney U Test was used to compare groups of variables that were not normally distributed. Results: The SPSIPB group had lower NRS values during post-operative 24 hours ( P < 0.001). Mean (standard deviation) total tramadol consumption was 58.33 (26.23) mg in the SPSIPB group and 144.17 (13.11) mg in the control group ( P < 0.001). Rescue analgesic need was lower in the SPSIP group in the first 18 post-operative hours ( P < 0.05). Conclusion: Serratus posterior superior intercostal plane block provides good analgesia in the thoracic region after video-assisted thoracoscopic surgery.

The study was conducted to evaluate the care burden and burnout levels of caregivers for patients hospitalized in palliative care. This descriptive study was conducted with 76 caregivers who were hospitalized in the palliative care services of a university and state hospital between 02.12.2019 and 02.06.2022 in Turkey. After obtaining the permissions of the ethics committee and the institution, the data were collected with the Descriptive Characteristics Form, Palliative Performance Scale, Caregivers Burden Inventory, and Maslach Burnout Inventory. The total score of the Caregivers Burden Inventory was 50.31±15.37, sub-dimensions of time-dependency burden, developmental burden, physical burden, social burden, and emotional burden scores were 18.30±3.23, 10.94±6.03, 13.54±5.99, 4.09±4.68, and 3.42±3.89, respectively. The Maslach Burnout Inventory sub-dimensions were emotional exhaustion, depersonalization, and personal accomplishment, with mean scores of 24.78±10.33, 11.59±4.20, and 28.64±5.67, respectively. The mean Palliative Performance Scale score of the patients was 32.76±16.86. As the burden of caregivers increased, so did their exhaustion scores. Caregivers had moderate care burdens, high time dependency and physical burdens, high emotional exhaustion, and low personal accomplishment burnout. All patients who were cared for were bedridden. The presence of incontinence in the patient affected the time dependency burden of the caregivers, and the presence of chronic disease in the caregiver and living with the patient also affected the caregivers' emotional exhaustion. These results show that studies must be conducted to develop multidisciplinary interventions to reduce caregivers’ care burden and burnout.

Purpose: This study aims to determine whether frontal QRS-T (fQRS-T) angle measurements assist in predicting prognosis in severe CCHF (Crimean-Congo Hemorrhagic Fever) patients. Material and Method: The study was conducted with 140 intensive care patients diagnosed with CCHF between 01.01.2012 and 2022. Demographic data and length of stay were recorded. In addition, laboratory data were recorded, including hemoglobin, troponin T, C-reactive protein, lymphocyte numbers, neutrophil, and platelet. fQRS-T angles were measured on electrocardiographic (ECG) data of the patients. Results: The mean fQRS-T angle was 53.9°±29.3° in non-survivors and 34.2°±17.3° in the survivors (p<0.001). Regarding non-survivors, they were older, and their hemoglobin, platelet and lymphocyte levels were lower (p<0.001), and their QRS durations were broader (p=0.021) than survivors. The fQRS-T angle cutoff value in predicting mortality was determined as 41.5°. For fQRS-T ≥41.5°, specificity was 61.1%, and sensitivity was 80.9% (area under the curve: 0.711, 95% CI: 0.624–0.798, p<0.001). Conclusion: Current study's results showed the usability of the fQRS-T angle as an inexpensive, convenient, strong, and repeatable predictor to determine the prognosis of CCHF patients. A detailed electrocardiographic evaluation in the routine follow-up of high-risk CCHF patients may indicate the prognosis of the disease.

Interscalene brachial plexus (ISB) block is widely used in shoulder and humerus surgeries, especially in patients that have high risk for general anesthesia. Increased intracranial pressure (ICP) is not among the complications of this block because there is no data about this issue in the literature. In this traumatic case report, a patient with headache and with a known meningioma in his right temporo occipital region is gonna have a proximal humerus fracture surgery with ISB block under repetitive optic nerve sheath diameter measurements. The result of this case report can add a unique information to the ISB literature.

Morphine is a drug used in chronic pain such as diabetic neuropathy, but the development of tolerance to its antinociceptive effect is an important clinical problem. Aspirin is an analgesic and antiapoptotic drug used in combination with morphine as an adjuvant in diabetic neuropathy. Our aim in this study was to investigate the effects of aspirin on morphine-induced neuronal apoptosis and analgesic tolerance in rats with diabetic neuropathy. The antinociceptive effects of aspirin (50 mg/kg) and morphine (5 mg/kg) were evaluated by thermal pain tests. Streptozotocin (65 mg/kg) was injected intraperitoneally to induce diabetic neuropathy. To evaluate apoptosis, ELISA kits were used to measure caspase-3, Bax and Bcl-2 levels. Apoptotic cells were detected histologically by terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling (TUNEL) method. Study results indicate that prior administration of aspirin to diabetic rats significantly increased the antinociceptive efficacy of morphine compared to morphine alone. Thermal pain tests showed that aspirin significantly reduced morphine tolerance in rats with diabetic neuropathy. Biochemical analysis revealed that aspirin significantly decreased the levels of pro-apoptotic proteins, caspase-3 and Bax, while increasing the anti-apoptotic Bcl-2 in DRG neurons. Semiquantitative scoring demonstrated that aspirin provided a significant reduction in apoptotic cell counts in diabetic rats. In conclusion, these data suggested that aspirin attenuated morphine antinociceptive tolerance through anti-apoptotic activity in diabetic rat DRG neurons.