Gülsüm Oya Hergünsel

Objective: A rare case of coinfection of Plasmodium falciparum and Aspergillus Fumigatus from travel to Tanzania is presented in this report. Methods: A-43-year-old, Turkish male patient who travelled to Tanzania for business without any malaria prophylaxis was admitted to hospital with high fever (39.5 degrees C), weakness, nausea and vomiting and dyspnea when returned to Turkey. The patient had been treated in intensive care unite for sepsis and multi organ dysfunction as a result of the delayed malaria diagnosis. In addition to the presence of thrombocytopenia, anemia, metabolic acidosis, acute respiratory distress syndrome, hepatosplenomegaly and acute renal failure, aspergillus fumigatus emerged as a secondary opportunistic infection. Consent was obtained from the patient’s family to publish and all patient specific information has been identified, as a case report and negligible risk to the patient; formal ethics approval was not required because it posed negligible risk to the patient. Results: He was treated with therapeutic plasma exchange seven times, prone position for 36 hours, continued renal replacement therapy for 72 hours, three cycles of artesunate, artemether lumefantrine for three days, with clindamycin and doxycycline. Additionally, meropenem for empirical antibiotherapy, and voriconazole and amphotericin b for Aspergillus were used. Conclusion: This case report showed that malaria should be suspected in patients with febrile illness and that travel history to a malaria-endemic region and when fever recurs during the treatment process, secondary opportunistic infections should be considered in addition to malaria. Pulmonary aspergillosis can be seen in people with supressed immune systems and should also be considered in patients with plasmodium falciparum. Since it has been shown that complications may continue even after the parasite load is eliminated, the addition of extracorporeal treatments to antimalarial therapy may be effective in reducing mortality.

Background: Candida species are major causes of hospital-acquired bloodstream infections associated with high mortality in critically ill patients. This study aimed to evaluate temporal changes in species distribution, antifungal resistance, clinical outcomes, and mortality predictors in ICU patients with candidemia. Methods: This retrospective study included 250 ICU patients with candidemia between January 2018 and January 2022. The study period was divided into two cohorts (2018–2020, n = 80; 2020–2022, n = 170). Clinical, laboratory, and microbiological characteristics were compared. Multivariable analysis was performed to identify independent predictors of mortality. Results: The incidence density of candidemia significantly decreased from 4.32 to 3.10 per 1,000 ICU patient-days (IRR: 0.72; %95 CI: 0.55–0.94; p = 0,014). A shift toward non-albicans Candida species was observed, while antifungal resistance rates remained stable. Candida score values and empirical antifungal therapy rates were lower in the later period. Despite increased central venous catheter use, catheter-related candidemia decreased. Overall mortality was similar between periods; however, during the second period, mortality was higher in patients with SARS-CoV-2 infection than in those without infection [100/105 (95.2%) vs. 43/65 (66.2%), p < 0.001]. In multivariable analysis, SOFA score was independently associated with mortality in the early period (OR: 1.20, 95% CI: 1.01–1.43; p = 0.043), whereas SARS-CoV-2 infection (OR: 20.43, 95% CI: 3.53–118.14; p = 0.001), Candida score (OR: 0.19, 95% CI: 0.06–0.50; p = 0.003), lactate level at ICU admission (OR: 5.23, 95% CI: 1.55–17.57; p = 0.007), and urea level at ICU admission (OR: 1.01, 95% CI: 1.00–1.02; p = 0.030) were independent predictors in the later period. Conclusion: The high mortality observed among patients with SARS-CoV-2–associated candidemia underscores the need for heightened diagnostic awareness in deteriorating ICU patients. Early diagnostic work-up, timely initiation of antifungal therapy, and reassessment of treatment according to microbiological findings are important in this setting. Hospital-specific identification of preventable risk factors may also help optimize candidemia management and infection control strategies.

Objective: Mechanical power (MP) is a promising parameter that may guide lung-protective ventilation strategies. The MP equation encompasses all variables involved in the pathogenesis of ventilator-induced lung injury (VILI), as well as the inspiratory-to-expiratory (I:E) ratio. Shortening the inspiratory time—by altering the I:E ratio—increases gas flow and may lead to lung injury. The optimal I:E ratio for preventing VILI remains uncertain. The present study aimed to investigate the effects of different I:E ratios on inspiratory gas flow and MP in patients with acute respiratory distress syndrome (ARDS). Materials and Methods: This study was conducted on 19 adult patients diagnosed with moderate ARDS who were admitted to the intensive care unit and received mechanical ventilation. Patients were ventilated at a PEEP level of 10 cmH2O, a tidal volume of 6 mL/kg, and three sequentially applied I:E ratios (1:2, 1:1, and 1.5:1), each maintained for 10 minutes. MP and respiratory parameters across the three I:E groups were compared using repeated-measures ANOVA. Results: Compared with the I:E ratio of 1:2, ventilation with an I:E ratio of 1:1 resulted in slower inspiratory gas flow, lower inspiratory resistance and peak inspiratory pressure, higher dynamic compliance, and lower MP values. Plateau pressure and driving pressure did not differ significantly. When comparing I:E 1:1 with I:E 1.5:1, a persistent slowing of inspiratory gas flow was observed, but no significant difference in MP was detected. Conclusion: In patients with ARDS, transitioning the I:E ratio from the conventional 1:2 to 1:1 or 1.5:1 resulted in progressively slower inspiratory gas flow and lower resistive and total mechanical power, suggesting that reducing inspiratory flow may enhance lung-protective ventilation.

By analyzing pregnancy-related intensive care unit (ICU) admissions in different populations, the key risk factors of maternal outcomes can be identified. The aim of this study was to examine and compare outcomes and healthcare costs of critical care among Turkish obstetric patients (TOP) and immigrant obstetric patients (IOP) who were admitted to ICU. This study was a retrospective cohort conducted at the intensive care unit of a Tertiary Care Hospital in Turkey. The data of all obstetric intensive care unit admissions over the period 2012–2018 were analyzed. Healthcare costs were also evaluated in both Turkish Lira and United States dollars ($). One hundred seventeen obstetric patients (75.2% TOP and 24.8% IOP) required ICU admissions over these 7 years. The average age of the IOP was significantly lower than that of the TOP (p < 0.05). It was determined that 39.8% (n = 35) of the TOP and 17.2% (n = 5) of the IOP were primiparous (p < 0.05). The TOP had a higher cesarean section rate (77.3%; n = 68) than the IOP (p < 0.05). The most common reasons for ICU admission were hypertensive disorders of pregnancy in both the TOP (36.4%) and the IOP (31.0%). IOP required antibiotic therapy more frequently (p < 0.05). The most common complication was acute kidney injury in both the TOP (17.0%) and the IOP (13.8%). Maternal death occurred in one of the IOP (3.4%) in six of the TOP (6.8%). The average cost of ICU during study period was 3682 Turkish liras ($1032) in Turkish citizen obstetric patients and 4585 Turkish liras ($1250) for immigrant patients. The critical care outcomes of immigrant and Turkish pregnant women were similar, except for some differences. The role of immigration status on the pregnancy, obstetric and gynecological critical care should be explored further.

How to Prevent Ventilator-Induced Lung Injury in Intraoperative Mechanical Ventilation? A Randomized Prospective Study - Turkish Journal of Anaesthesiology and Reanimation

ÖZ Amaç Şiddetli akut solunum yolu yetersizliği koronavirüs sendromu-2 etkenli viral sepsisi diğer patojenlere bağlı gelişen pnömosepsis ile karşılaştırarak; patojen-konak ilişkisi, kliniği etkileyen organ hasarı, iki sepsis türünün benzer ve farklı özelliklerinin karşılaştırılması amaçlandı. Gereç ve Yöntem 2019 ve 2021 yılları arasında kritik koronavirüs hastalığı-2019 (COVİD-19) tanısı alan toplam 414 hasta ve 2016 ve 2019 yılları arasında anesteziyoloji ve reanimasyon yoğun bakım ünitesine (YBÜ) başvuran ve sepsis-3 tanı kriterlerini karşılayan 303 pnömopsis olgusu retrospektif olarak tarandı. Hastaların demografik verileri, mortalite oranları, yoğun bakımda kalış süreleri, sekonder organ disfonksiyonu gelişimi, laboratuvar ve mekanik ventilasyon başvuru değerleri ve bir haftalık takipteki değişimleri karşılaştırıldı. Bulgular Sıralı organ yetmezliği değerlendirmesi skorları COVİD-19 sepsis grubunda başvuruda (8,2±2,9’a karşı 7,2±3,7; p

Background and objectives: Preoperative anxiety is an enormous feeling of fear that is seen in all patients undergoing surgery. The severity of anxiety may vary depending on the type of surgery and anesthesia to be performed. The aim of this study is to compare the effects of brachial plexus blocks and general anesthesia methods on preoperative anxiety levels in patients who will undergo orthopedic upper-extremity surgery and to determine the factors affecting anxiety. Materials and Methods: After randomization, the Amsterdam Preoperative Anxiety and Knowledge Scale (APAIS) questionnaire was applied to the patients to determine the preoperative anxiety level, and then anesthesia was applied according to the anesthesia type determined. Pain scores (1, 8, 16, and 24 h) and total opioid consumption of the patients were recorded postoperatively. Results: The APAIS score of the patients in the general anesthesia (GA) group was significantly higher (p = 0.021). VAS score medians at 1, 4, and 8 h postoperatively were found to be significantly higher in the GA group (p < 0.001, p < 0.001 and p = 0.044, respectively). Conclusions: USG-guided BPB may cause less anxiety than GA in patients who will undergo elective upper-extremity surgery. However, these patients have moderate anxiety, although it is more associated with advanced age, female gender, and education level.

The epigenetic features contribute to variations in host susceptibility to SARS-CoV-2 infection and severity of symptoms. This study aimed to evaluate the relationship between the relative expression of microRNAs (miRNAs) and the severity of the disease in COVID-19 patients. The miRNA profiles were monitored during the different stages of the disease course using reverse transcription–quantitative polymerase chain reaction (RT-qPCR). The expression levels of the selected 11 miRNAs were measured in the blood samples collected from 73 patients (moderate, n = 37; severe, n = 25; critically ill, n = 11, a total of 219 longitudinal samples) on hospitalization day and days 7 and 21. Expression changes were expressed as “fold change” compared to healthy controls (n = 10). Our study found that several miRNAs differed according to disease severity, with the miR-155-5p the most strongly upregulated (p = 0.0001). A statistically significant negative correlation was observed between the expression of miR-155-5p and its target gene, the suppressor of cytokine signaling 1 (SOCS1). The relative expression of miR-155-5p was significantly increased and SOCS1 was significantly decreased with the disease progression (r = −0.805 p = 0.0001, r = −0.940 p = 0.0001, r = −0.933 p = 0.0001 for admission, day 7, and day 21, respectively). The overexpression of miR-155-5p has significantly increased inflammatory cytokine production and promoted COVID-19 progression. We speculated that microRNA-155 facilitates immune inflammation via targeting SOCS1, thus establishing its association with disease prognosis.