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Significantly impacts quality of life. In this context, the objective of this study is to investigate the relationship between serum 25-hydroxyvitamin D [25(OH)D] levels and the severity, duration, and neuropathic symptoms of PHN. Material and Methods: The sample of this retrospective observational cohort study consisted of 71 patients who were followed up with a diagnosis of PHN between January 2020 and June 2024. Patients were stratified into three groups according to their serum 25(OH)D levels as patients with vitamin D deficiency (≤20 ng/mL, n=24), vitamin D insufficiency (21-29 ng/mL, n=26), and vitamin D sufficiency (≥30 ng/mL, n=21). Patients’ neuropathic pain was assessed using the Douleur Neuropathique 4 (DN4) questionnaire and the Numeric rating scale (NRS). Inflammatory parameters such as C-reactive protein (CRP) level, erythrocyte sedimentation rate (ESR), and leukocyte count were recorded for each patient, and the diagnostic performance of their serum 25(OH)D levels was evaluated by receiver operating characteristic (ROC) curve analysis. Results: The mean DN4 and NRS scores and pain duration of the patients with vitamin D deficiency were significantly higher than those of other patients (5.83±1.76 vs. 1.71±0.96, p

Background/Objectives: High thoracic erector spinae plane block (ESPB) is a novel technique for managing chronic radicular and sympathetically mediated pain. Although physiological changes, such as increased skin temperature, perfusion index (PI), and optic nerve sheath diameter (ONSD), are known to reflect ESPB-induced sympatholysis, their predictive value for analgesic success remains unclear. In this context, the objective of this study is to investigate whether these objective indicators of sympathetic blockade are associated with the clinical success of high thoracic ESPB. Methods: The sample of this prospective, observational study consisted of 35 adult patients with chronic radicular pain undergoing a high thoracic ESPB procedure. Pre- and post-procedure assessments included bilateral skin temperature, PI, ONSD measurements, and administration of a visual analog scale (VAS). Patients with a greater than 50% decrease in VAS score were deemed responders to the procedure. Results: Of the 35 patients, 29 (82.9%) were responders. The patients’ post-procedure ipsilateral skin temperature (p < 0.001), PI (p = 0.002), and ONSD (p < 0.001) values were significantly higher than their pre-procedure values. However, none of these parameters differed significantly between responders and non-responders (p > 0.05). There was also no significant correlation between VAS score and changes in PI, ONSD, or skin temperature (p > 0.05). Conclusions: In conclusion, although high thoracic ESPB resulted in measurable physiological changes suggestive of sympathetic blockade, these changes did not predict clinical analgesic success.

Purpose: This study aimed to evaluate the relationship between diaphragm and rectus abdominis (RA) muscle thickness and mortality, morbidity, and weaning success from mechanical ventilation in intensive care unit (ICU) patients. Materials and methods: A total of 87 adult ICU patients were included. Diaphragm and RA muscle thicknesses were measured via ultrasound on the 1st, 3rd, 7th, and discharge days of ICU stay. Clinical data, including mechanical ventilation status, weaning outcome, infections, and the use of sedation, inotropes, and steroids, were recorded. Results: Invasive mechanical ventilation (IMV) was applied in 82.7% of patients. Weaning was successful in only 15.2% of IMV patients. On the discharge day, diaphragm and RA thicknesses were significantly lower in the IMV group than in the non-IMV group (p=0.029, p=0.004, respectively). RA thickness was significantly higher on day 1 in the successfully weaned group (p=0.03). Diaphragm thickness showed a weak positive correlation with BMI. A weak negative correlation was found between RA thickness and NUTRIC score. No correlation was observed between muscle thicknesses and age, APACHE-II or SOFA scores. Conclusion: Monitoring diaphragm and RA muscle thickness may guide the assessment of weaning and mortality risk in ICU patients. Particularly, RA thickness may serve as a potential biomarker for predicting weaning success.

Purpose: It is observed in studies that subclinical seizures have significant impact on the diagnosis, prognosis, and treatment responses. Aim of our study is investigating presence of these seizures, their relationship with sleep, contribution to diagnosis, and impact on treatment selection and prognosis in patients diagnosed with focal epilepsy. Materials and methods: Total of 1,626 EEGs conducted in the EEG unit were examined. Among them, 626 were found to belong to patients diagnosed with focal epilepsy. 140 patients who underwent twenty-minute EEG monitoring and 28 patients who underwent twenty-four-hour EEG monitoring were included in the study. Results: A comparative analysis was conducted between two cohorts of patients: one subjected to a twenty-minute EEG and the other undergoing a 24-hour EEG. In the presence of resistant epilepsy, the risk of SCS is increased by 3.1 times. The presence of SCS in frontal lobe epilepsies demonstrated a 2.2-fold elevation compared to temporal lobe epilepsies (1.0-5.3). A statistically significant relationship between Levetiracetam usage and seizures was observed (p=0.044). The calculated Odds Ratio for risk indicated a 1.2-fold (1-1.6) higher frequency of seizures with Levetiracetam usage. Risk analysis revealed a 1.5-fold (1.2-1.9) higher incidence of seizures with the use of well-known drugs in favor of lacozamide-zonisamide. Conclusion: SCSs are gaining increasing clinical significance in terms of diagnosis, prognosis, and treatment. The relationship between these sleep and SCSs holds importance for future research with a larger number of patients and centers.

Amaç: Bu çalışmanın amacı; mavi kod uygulamasının önemi, etkinlik ve güvenilirliğine dikkat çekmek, işleyişteki aksaklıklar, sorunlar ve bunlarla ilgili çözüm önerilerini paylaşmaktır. Gereç ve Yöntemler: 2018-2022 yıllarında Mavi Kod Bildirim Formları (MKBF) retrospektif olarak incelendi. Yaş, cinsiyet, çağrının verildiği birim, çağrının verildiği saat ve zaman dilimi, ekibin ulaşma zamanı, olası nedenler ve uygulama sonuçları değerlendirildi Bulgular: Kayıtlara geçen 192 mavi kod çağrısının (MKÇ) 86’sı (%44,8) kadın, 106’sı (%55,2) erkek, yaş ortalaması 53,23 olarak saptandı. Müdahale yeri oranlarına bakıldığında en büyük oranın hastane koridorları ve bekleme salonları olduğu görüldü. Öğleden önce ve öğleden sonra olan çağrılarda sayısal açıdan istatistiksel olarak anlamlı bir fark görülmedi. Ekiplerin %70 oranında 1 dakikadan kısa sürede çağrı noktasına ulaştığı gözlendi. Olay yerinde konan ön tanılara bakıldığında senkop ilk sırada yer aldı. Çağrıların ileri yaşam desteği gerektiren durumlarına bakıldığında; 51 çağrının resüsitasyon gerektirdiği, diğer çağrıların basit tıbbi müdahale ile yönetilebilir olduğu görüldü. Müdahale yerlerinde MKÇ’nin gerçek olması ve resüsitasyon ihtiyacı ilişkisine bakıldığında işlem ünitelerindeki çağrıların mavi kod olma olasılığının belirgin yüksek olduğu (p

ÖZ Amaç Tocilizumab (TCZ), kritik durumdaki koronavirüs hastalığı-2019 (COVİD-19) hastalarında fayda sağlayan, rekombinant bir anti-interlökin-6 reseptörü monoklonal antikordur. Bununla birlikte, COVİD-19 hastalarında immünosüpresan tedavilerin (TCZ, sarilumab ve anakinra dahil) klinik etkinliği ve güvenliği henüz bilinmemektedir. Bu tedaviler hastaları enfeksiyona yatkın hale getirebilir. Bu çalışmanın amacı, TCZ kullanımı ile artmış sekonder bakteriyel enfeksiyonlar arasında herhangi bir bağlantı bulmaktır. Gereç ve Yöntem Bu çalışmada yoğun bakım ünitesindeki (YBÜ) COVİD-19 hastalarında sekonder bakteriyel enfeksiyonların retrospektif analizlerini yaptık. Bu çalışmaya Mart 2020 ile Ocak 2022 tarihleri arasında üniversite hastanesinin yetişkin YBÜ’lerine kabul edilen laboratuvarca doğrulanmış COVİD-19 enfeksiyonu veya klinik ve radyolojik olarak doğrulanmış COVİD-19 enfeksiyonu olan hastalar dahil edilmiştir. Demografik veriler, yakın zamandaki maruziyet ve seyahat öyküsü, klinik semptomlar veya bulgular, laboratuvar bulguları ve eşlik eden hastalıklar kaydedildi. Trakeal aspiratlardan, kan ve idrardan mikrobiyal kültürler, hastaneye yatışta ve hastanede kaldıkları süre boyunca alındı. TCZ tedavisi alan hastalar sekonder enfeksiyonları not etmiş ve analiz etmişlerdir. Kan kültürleri ilk TCZ dozundan en az 48 saat sonra alınmıştır. Bulgular Seksen hastada (%37) başvuru sırasında kültür örneğinin pozitif olduğunu ve bu olguların çoğunun çeşitli hastane servislerinden YBÜ’ye kabul edildiğini saptadık. Analiz edilen veriler, TCZ grubunun pozitif kültür örnekleri insidansının daha yüksek olduğunu gösterdi (%75’e karşı %35, p=0,0001). Sonuçlar, TCZ kültürü alan hastalarda metisilin direnci insidansının daha yüksek olduğunu göstermiştir. Staphylococcus aureus, Klebsiella spp. ve Acinetobacter spp. (p=0,0001). Enfeksiyon oranı ve ölüm oranı normal bakım grubundan çok daha yüksekti. Sonuç Sekonder enfeksiyonlar ve sepsis mortalite için önemli bir risktir. Tespit edilen patojenler ilaca dirençliydi ve tedavi şansı daha düşüktü. Bu hastalarda sekonder enfeksiyonlar nedeniyle TCZ tedavisinin yararı kaybolmuştur. TCZ tedavilerinin risklerini belirlemeye yardımcı olmak için gelecekteki çalışmalara ihtiyaç vardır.

Background: Data regarding lacosamide treatment as an adjunctive therapy in patients representative of a focal-onset epilepsy population including those with and without intellectual/developmental disorders (IDDs) are limited. Purpose: To evaluate the retention rates of lacosamide in focal-onset epilepsy patients with and without IDD. Patients and methods: We retrospectively reviewed all consecutive electronic and paper medical records of patients diagnosed with focal-onset epilepsy who were treated with lacosamide in two tertiary epilepsy centers. Results: One hundred and thirty-six patients who met the inclusion criteria were studied. Number of patients with IDD was 46 (33.8%). Median lacosamide dose was 300 mg/day. A total of 39 patients (28.7%) experienced side effects, and 22 of them (16.2%) discontinued lacosamide. The 1-, 2-, and 3-year retention rates of lacosamide in patients with IDD were 68%, 62%, and 53%, respectively. Kaplan–Meier survival analysis showed that the retention rates were significantly lower in patients with IDD when compared to patients without IDD (P=0.04). Cox regression analysis showed that concomitant use of sodium channel blocker antiepileptic drugs (AEDs) was the only independent predictor of retention rate of lacosamide treatment (P=0.03). In the subgroup of patients with IDD, the analysis was performed again and the number of background AEDs was the only predictor for the retention rate of lacosamide (P=0.04). Conclusion: When compared to patients without IDD, retention rates of lacosamide adjunctive therapy were lower in patients with IDD. However, these rates were higher than the rates suggested with previously registered AEDs including lamotrigine, levetiracetam, and topiramate. Therefore, irrespective of having comorbid IDD, we might suggest that lacosamide is a well-retained drug with a high efficacy profile in patients with focal-onset epilepsy.