Almıla ÜYÜK

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.

We present a case of idiopathic membranous glomerulonephritis that presented with venous thromboembolism and was successfully managed with corticosteroid, cyclosporin, appropriate anticoagulant therapy. A 59-year old male patient was referred to our nephrology department who had an outpatient history of swelling in the feet and flank pain was detected proteinuria and thrombosis in the inferior vena cava. Warfarin sodium treatment was started when thrombus was detected in the femoral vein, renal vein and inferior vena cava in the imaging. The patient had 12 g/day proteinuria, hypoalbuminemia, hyperlipidemia and antiphospholipase A2 receptor antibody positivity and treatment was started with the diagnosis of idiopathic membranous nephropathy. The patient who was discharged with oral steroid, cyclosporine and warfarin sodium, but warfarin sodium was changed to rivaroxaban in another clinic due to incompatibility problems, was presented again with dsypnea. Pulmonary embolism was detected. Rivaroxaban was discontinued and low molecular weight heparin treatment was started. There was a very high risk of morbidity and mortality and with appropriate treatment, clinical status and renal function were stabilized. In conclusion, although thromboembolism can be seen in nephrotic syndrome, it may rarely be encountered as the first presentation of nephrotic syndrome. This situation should not be overlooked, appropriate treatments should be provided without delay.