Semiha Orhan

Background/Objectives: This study aimed to evaluate the associations of adding oXiris hemoadsorption therapy to standard sepsis treatment with inflammatory markers, organ dysfunction, hemodynamic parameters, respiratory function, and overall survival (OS) in patients with sepsis and septic shock managed in the intensive care unit (ICU). In our ICU, oXiris was used as adjunctive hemoadsorption for endotoxin and cytokine removal, delivered on a continuous venovenous hemodiafiltration (CVVHDF) platform and initiated independently of acute kidney injury (AKI). Methods: This retrospective comparative cohort study included 83 adult patients with sepsis or septic shock admitted to the Internal Medicine ICU. Patients were allocated to either the oXiris group (n = 33), which received oXiris hemoadsorption for 72 h in addition to standard sepsis therapy, or the control group (n = 50), which received standard sepsis therapy without oXiris or another adsorptive CRRT membrane. Conventional intermittent hemodialysis for independent renal indications was permitted and recorded in both groups. C-reactive protein (CRP), procalcitonin (PCT), white blood cell count, updated Sequential Organ Failure Assessment (SOFA-2) score, PaO₂/FiO₂ ratio, serum lactate, norepinephrine dose, and renal parameters were recorded at baseline, 48 h, and 72 h. Between-group differences in temporal changes were evaluated using adjusted generalized estimating equation models, and robustness was assessed with a propensity-score-based inverse-probability-of-treatment-weighted (IPTW) sensitivity analysis. Survival analysis was performed using the Kaplan–Meier method and log-rank test. Results: The oXiris group had significantly greater baseline clinical severity, including a higher burden of renal dysfunction. This marked baseline imbalance was considered important when interpreting the unadjusted findings and supported the use of adjusted and IPTW analyses. In the oXiris group, CRP, PCT, SOFA-2 score, and norepinephrine requirement showed greater reductions over time, whereas the PaO₂/FiO₂ ratio improved significantly. After IPTW adjustment, the between-group differences in SOFA-2 score, norepinephrine requirement, and PaO₂/FiO₂ ratio remained statistically significant, whereas the CRP and PCT differences were no longer statistically significant. Serum lactate levels showed an increasing trend in the oXiris group compared with the control group (p = 0.042). No significant difference in overall survival was observed between the two groups (p = 0.897). Conclusions: The addition of oXiris hemoadsorption to standard sepsis therapy was associated with favorable early temporal changes in organ dysfunction, norepinephrine requirement, and oxygenation. However, the observed CRP and PCT differences were not preserved after IPTW adjustment, and no survival association was identified. These findings should therefore be interpreted as associations rather than evidence of a causal treatment effect.

Background/Objectives: We investigated the association of serum ferritin and procalcitonin (PCT) with Sepsis-related Organ Failure Assessment (SOFA)-2 score-based organ dysfunction severity in intensive care patients with COVID-19-associated sepsis. Methods: Patients were stratified by day 5 ferritin (ng/mL) and PCT (μg/L) levels; associations were analysed across severity groups defined by an SOFA-2 score of p > 0.05). The optimal day 5 ferritin cut-off was >1191 ng/mL (35.78% sensitivity, 82.38% specificity; area under the curve (AUC) = 0.608). Day 5 ferritin was associated with SOFA-2 severity in the univariable analysis but did not remain an independent correlate after adjustment for C-reactive protein (CRP) and lactate dehydrogenase (LDH); in a mortality model, neither ferritin nor PCT independently predicted intensive care unit (ICU) death. PCT provided no predictive value beyond existing inflammatory markers, consistent with its suppression during viral infections. Conclusions: Day 5 ferritin reflects, rather than independently predicts, organ dysfunction severity and may complement, rather than replace, established multi-parameter scoring. Relative to the independent determinants of severity and mortality (PaO₂/FiO₂ ratio, LDH, CRP, and age), day 5 ferritin is a specific, rule-in adjunctive marker of concurrent organ dysfunction rather than a standalone prognostic tool. Whether these associations extend to non-COVID sepsis populations requires prospective study.

Glioblastomas (World Health Organization [WHO] grade 4) are the most lethal primary brain tumors, with a median overall survival (OS) of 12-15 months despite multimodal treatment. MGMT promoter methylation and TERT promoter mutations are key prognostic biomarkers, but their combined utility remains incompletely defined. This study evaluated the prognostic effects of MGMT methylation, TERT mutations, and adjuvant treatment. We retrospectively analyzed 65 patients with gliomas treated between January 2013 and December 2024, with primary analyses restricted to WHO grade 4 tumors (n = 54). MGMT methylation was assessed by methylation-specific PCR and TERT mutations (C228T/C250T) by Sanger sequencing. Survival was analyzed using Kaplan-Meier methods and multivariable Cox regression with bootstrap validation. In the grade 4 cohort, median OS was 12.7 months. MGMT methylation was present in 50.0% and TERT mutations in 68.5%. MGMT methylation independently predicted improved survival (aHR 0.45, 95% CI 0.24-0.87, p = 0.018), while TERT mutation predicted worse survival (aHR 2.93, 95% CI 1.46-5.87, p = 0.003). Adjuvant chemoradiotherapy was associated with improved OS (aHR 0.44, 95% CI 0.24-0.81, p = 0.008). Combined stratification identified four prognostic subgroups, with MGMT-methylated/TERT-wild-type patients showing the longest survival (median OS 19.0 months). The model demonstrated acceptable discrimination (C-index 0.697). MGMT methylation and TERT mutations are independent prognostic markers in glioblastoma. This study provides real-world evidence that both biomarkers retain prognostic value after adjustment for adjuvant treatment within an internally validated model. Combined MGMT/TERT assessment provides clinically meaningful four-tier risk stratification and supports routine prognostic evaluation.

Aims: The angiotensin converting enzyme 2 (ACE 2) molecule, which mediates the entry of the virus into the cell, plays a very important role in the pathogenesis of COVID-19 disease. However, its effect on prognosis has not been fully explained. In this study, it was aimed to investigate the relationship between soluble ACE 2 (sACE 2) levels in the blood and the course of the disease. Methods: sACE 2 levels at 0, 3 and 5 days were measured in patients with mild, moderate and severe COVID-19 pneumonia who were hospitalized between March 15, 2020 and August 30, 2020. Results: 69 patients, 35 (51.5%) female and 34 (49.3%) male, with a mean age of 64.3±2.1 were included in the study. 42.0% of the patients had mild, 30.4% moderate, 27.5% severe pneumonia. Clinical follow-up of 7 patients resulted in death. There was no statistically significant difference between sACE 2 levels and gender, severity of pneumonia, initial hospitalization, presence of intubation and mortality. Conclusion: sACE 2 levels were not associated with disease severity and inflammatory markers. Studies in larger patient populations are needed to explain the relationship between sACE 2 activity and SARS-CoV-2 infection and to develop new treatment strategies.

Objective: Acute Kidney Injury (AKI) is a prevalent condition among patients admitted to the intensive care unit (ICU), with high incidence and increased mortality rates. AKI often induces the elevation of inflammatory biomarkers used for diagnosing infection. This study aimed to investigate changes in inflammatory markers in the setting of AKI. Methods: This retrospective study included patients admitted to the ICUs of Burdur State Hospital between January 2019 and January 2023. Data from 958 patients were analyzed, and AKI was classified by the Acute Kidney Injury Network (AKIN) criteria. Only creatinine data were used as information on urine output was not available. The cohort was stratified into following groups: no AKI (AKI 0), b) creatine levels between 1.60 and 2.50 mg/dL (AKI I), creatine levels between 2.51 and 3.99 mg/dL (AKI II), and creatine levels above 4 and receiving renal replacement therapy (AKI III). Results: Of the 958 patients, male and female distribution was 55.1% (n= 528) and 44.9% (n= 430) respectively. The median age of the study cohort was 79 years (IQR=18.3 years). Neutrophil-to-lymphocyte ratio, procalcitonin, and C-reactive protein levels were found to increase significantly in direct relation to the severity of AKI (p<0.001). Furthermore, in infected patients, these inflammatory biomarkers were found to increase in parallel with the severity of AKI compared to non-infected patients (p<0.001). Conclusion: Inflammatory biomarkers rise as the severity of renal failure increases. The combined use of neutrophil-to-lymphocyte ratio, procalcitonin, and C-reactive protein levels in patients with renal failure would be more effective for diagnosing infection.

Aim: COVID-19 (coronavirus disease 2019) pneumonia is a serious condition with high mortality and morbidity. Tools are needed for effective diagnosis and better prediction of prognosis in the course of this disease. This study aimed to compare the effectiveness of the MuLBSTA (Multilobular infiltration, hypo-Lymphocytosis, Bacterial coinfection, Smoking history, hyper-Tension and Age) score with blood parameters, SOFA (Sequential Organ Failure Assessment), and APACHE II (Acute Physiology and Chronic Health Evaluation II) scores, and to investigate its significance in predicting 28-day mortality in patients diagnosed with COVID-19 and followed up in the intensive care unit (ICU). Material and Method: This study included 312 patients admitted to ICU for COVID-19 infection. SOFA, MuLBSTA and APACHE-II scores of patients were estimated at ICU admission. Demographic data and laboratory results of patients were retrospectively reviewed. Results: Of the 312 patients included in the study, 58.7% (n=183) were male and 41.3% (n=129) were female. The AUC value was 0.863 for the SOFA score and 0.843 for the MuLBSTA score. The MuLBSTA score was positively correlated with the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR), while it was negatively correlated with the lymphocyte-to-monocyte ratio (LMR). Patients were divided into two groups as high-risk and low-risk, considering a cut-off value of 12 for the MuLBTSA score. The survival time of patients with a high-risk MuLBTSA score was 12±0.78 days, while the survival time of patients with a low MuLBTSA score was 22.8±1.3 days. Conclusion: The combined use of the MuLSBTA score, SOFA score, and NLR after ICU admission for COVID-19 pneumonia will be more effective in predicting mortality.

Amaç: Trakeostomi işlemi uzamış entübasyon nedeniyle cerrahi yada perkütan teknik kullanılarak yapılan bir işlemdir. Bu işlem sırasında hava yolu güvenliği laringeal maske (LMA) ya da endotrakeal tüp (ETT) ile sağlanmaktadır. Bu çalışmada trakeostomi işlemi esnasında LMA ve ETT kullanımının komplikasyonlarını, işlem süresini ve kan gazı verilerindeki değişimlerini incelmeyi amaçladık. Gereç ve Yöntem: Çalışmaya 2019-2023 yılları arasında Burdur Devlet Hastanesi Yoğun Bakım Kliniklerinde yatan hastalar dahil edilmiştir. Çalışmaya dahil edilen 78 hasta; ETT (n=39) ve LMA (n=39) kullanılanlar olarak iki gruba ayrılmıştır. İşleme ait komplikasyonlar, işlem süreleri, hastaların kan gazı verileri hasta dosyalarından kaydedildi. Bulgular: Gruplar arasında komplikasyonlar açısından istatistiksel fark bulunmadı. LMA ve ETT ile trakeostomi açılan gruplar arasında işlem sonrası PaCO2 değerlerinde istatiksel olarak anlamlı fark yoktu (p<0.439). Trakeostomi öncesi ve sonrası PaO2 değerleri değerlendirildiğinde, hem LMA ve hem de ETT gruplarında düşme olduğu görüldü (her ikisi için de) (p<0,001). Trakeostomi işlemi süreleri karşılaştırıldığında ise LMA grubunda sürenin ETT grubuna göre istatistiksel anlamlı olarak daha kısa olduğu görüldü (p<0,001). Sonuç: Çalışmamızda komplikasyonlar ve kan gazında meydana gelen değişimler açısından LMA ve ETT arasında herhangi istatistiksel olarak bir fark olmadığı görülmüştür. LMA ile trakeostominin ETT ye göre işlem sırasında daha az personel ihtiyacı olması, bronkoskopide görüş netliği ve işlem süresinin daha kısa olması gibi avantajları vardır. Aim: Tracheostomy is a common procedure performed surgically or percutaneously due to prolonged intubation. During the procedure, airway safety can be ensured using a laryngeal mask airway (LMA) or an endotracheal tube (ETT). The aim of this study was to investigate the complications associated with the use of LMA and ETT during the tracheostomy procedure, operative time, and changes in blood gas parameters. Materials and Methods: This study included patients admitted to the Intensive Care Units of Burdur State Hospital between 2019 and 2023. A total of 78 patients were divided into two groups: ETT (n=39) and LMA (n=39). Procedure-related complications, operative time, blood gas data were recorded from the patient files. Results: There was no statistically significant difference between the LMA and ETT groups in terms of complications. There was also no statistically significant difference in postoperative values of PaCO2 between the groups (p<0.439). The analysis of pre- and post-tracheostomy PaO2 values indicated a decrease in both the LMA and ETT groups (p<0.001 for both). The comparison of the two groups by the duration of the tracheostomy procedure showed a statistically significant shorter operative time in the LMA group than in the ETT group (p<0.001). Conclusion: Our study demonstrated no statistically significant difference between LMA and ETT in terms of complications and changes in blood gas parameters. Tracheostomy with LMA has advantages over ETT, fewer personnel requirements during the procedure, clear vision in bronchoscopy, and shorter operative time.

Aim: To evaluate the inflammatory parameters and oxygenation in severe coronavirus disease-19 patients who underwent extracorporeal cytokine adsorption (CA).Methods: Patients who underwent extracorporeal CA for cytokine storm were included in the study. The changes in oxygenation, laboratory parameters, and mortality rates were investigated.Results: Thirty-six patients were included in the study. The hemoglobin, thrombocyte, and C-reactive protein (CRP) decreased, and PaO2/FiO(2) ratio increased (p < 0.001; p < 0.01; p < 0.001; p = 0.04, respectively). Twelve (33.3%) patients received a single session, 24 (66.6%) received 2 or more sessions. CRP and fibrinogen levels decreased, and PaO2/FIO2 ratio increased in the single session group (p = 0.04; p = 0.04; p = 0.01, respectively). In the multi-session group, the hemoglobin, platelet, procalcitonin, and CRP levels decreased, and PaO2/FIO2 ratio increased (p < 0.01; p = 0.02; p = 0.02; p < 0.01; p = 0.01, respectively). Day 15, 30, and 90 mortality rates were 61.1%, 83.3%, and 88.9%.Conclusion: CA with hemoperfusion reduced CRP and improved oxygenation; however, mortality rates were high.

In this study, we aimed to evaluate the effect of monocyte/high-density lipoprotein (MHR), which is associated with systemic inflammation: on prolonged hospitalization in patients with mild acute pancreatitis. Patients hospitalized for acute edematous pancreatitis between 01.01.2021 and 31.12.2021 were retrospectively screened. Arrival Ranson scores of the patients were calculated. Those with a Ranson score <3 were considered as mild acute pancreatitis and were included in the study. Patients with mild acute pancreatitis were divided into 2 groups with a hospital stay of <8 days and ≥8 days. Monocyte/HDL, biochemical and metabolic parameters were compared between the groups. The study was conducted with a total of 39 patients, 23 male (59%) and 16 female (41%). While 28 (71.8%) of the patients were discharged within <8 days, 11 (28.2%) were hospitalized for ≥8 days. Group ≥8 days was considered as prolonged hospitalization. It was determined that the monocyte/HDL ratio was significantly higher in the group with prolonged hospitalization between the groups. In univariate analyzes, it was determined that the presence of Diabetes Mellitus and MHR increased the risk of prolonged hospitalization by 5.25 times and 1.085 times, respectively. In the multivariate analysis of these two parameters, MHR was found to be an independent risk factor for prolonged hospitalization. It was concluded that monocyte/HDL can be used as a simple and reliable parameter to predict the duration of hospitalization in patients with mild acute pancreatitis.

Introduction: The aim of this study was to determine the indications of Percutaneous endoscopic gastrostomy (PEG) patients treated in a secondary state Burdur hospital over a period of three years, the unit where the patient was hospitalized, survival time with PEG therapy, and the complications observed in these patients. Methods: Patients who underwent PEG in the endoscopy unit of our hospital, between January 2019 and January 2022, were retrospectively evaluated. Age, gender, the unit of inpatient, indications for PEG therapy, complications after PEG, and survival status of the patients were recorded in the form of case reports. Patients with coagulation disorders, hemodynamic instability, peritonitis, sepsis, infection at the insertion area, peritonitis carcinomatosis, a history of total gastrectomy and gastric varices were excluded. Results:The median age of the 120 patients included in the study was 79 (17–100) years, and 66 (55%) of the patients were male. Complications were observed in 14 (11.7%) patients, all of which were minor, including seven (5.8%) PEG site infections, three (2.5%) PEG site leakages, three (2.5%) PEG occlusions, and one (0.9%) PEG removal. It was determined that 73 (60.8%) patients survived at least 30 days; the patients were most frequently referred by the neurology unit, with a rate of 52.7%. The most common indications for PEG insertion were cerebrovascular disease (56.7%) and dementia (29.2%). Conclusion: Maintenance of nutritional requirements via PEG allows for the preservation of mucosal integrity and barrier function, intestinal immune response, and normal flora. It is superior to other enteral feeding methods due to the lower risk of aspiration. In conclusion, our study, which presented the experiences of the PEG insertion and therapy in a secondary state hospital, stated that the complication rates, indications, and referring clinics were found to be consistent with available literature.