Comparison of Conventional Intensive Care Scoring Systems and Prognostic Scores Specific for Intracerebral Hemorrhage in Predicting One-Year Mortality.

BACKGROUND: Specific prognostic models for intracerebral hemorrhage (ICH) have short and simple features, whereas intensive care unit (ICU) severity scales include more complicated parameters. Even though newly developed ICU severity scales have disease-specific properties, they still lack radiologic parameters, which is crucial for ICH. AIMS: To compare the performance of the Simplified Acute Physiology Score (SAPS) III, Acute Physiology and Chronic Health Evaluation (APACHE) IV, Logistic Organ Dysfunction Score (LODS), ICH, max-ICH, ICH functional outcome score (ICH-FOS), and Essen-ICH for prediction of in-hospital and one-year mortality of patients with ICH. METHODS: A single-center analysis of 137 patients with ICH was conducted over 5 years. The performance of scoring systems was evaluated with receiver operating characteristic analysis. The independent predictors of one-year mortality were investigated with a multivariate logistic regression analysis. The SAPS-III score was calculated both in the emergency department (ED) and ICU. RESULTS: Among the independent variables, the need for mechanical ventilation, hematoma volume, the presence of intraventricular hemorrhage, and hematoma originating from both lobar and nonlobar regions were found as the strongest predictor of one-year mortality. For in-hospital mortality, the discriminative power of SAPS-II, APACHE-IV, and LODS was excellent, and for SAPS-III-ICU and SAPS-III-ED, it was good. For one-year mortality, the discriminative power of SAPS-II, APACHE-IV, LODS, and SAPS-III-ICU was good, and for SAPS-III-ED, Essen-ICH, ICH, max-ICH, and ICH-FOS, it was fair. CONCLUSIONS: Although all three ICH-specific prognostic scales performed satisfactory results for predicting one-year mortality, the common intensive care severity scoring showed better performance. SAPS-III scores may be recommended for use in EDs after proper customization.

Frequency of vitamin K oxidoreductase complex subunit-1 (VKORC1) polymorphisms and warfarin dose management in patients with venous thromboembolism.

Warfarin works by inhibiting VKORC1, so polymorphisms of this gene modify the required drug dose. The aim of this study is to examine the relation between therapeutic weekly dose of warfarin and C1173T/G1639A polymorphism of VKORC1 in patients with VTE. Seventy-five patients with VTE were enrolled. Weekly warfarin doses and time (day) to reach therapeutic INR were evaluated retrospectively along with VKORC1-C1173T and G1639A alleles. The mean weekly warfarin dose was lower and time to reach therapeutic INR was shorter in homozygote alleles (AA and TT) (p < 0.05). The multivariate regression model was produced, R2 = 0.05% for age (p = 0.04), R2 = 6% for VKORC1 (p = 0.03), the model for estimating warfarin dose R2 = 17% (p > 0.05). In particular, patients who need overdose of warfarin or whose bleeding score is high, study of these polymorphisms can be considered.

High serum YKL-40 level is associated with poor prognosis in patients with lung cancer.

INTRODUCTION: YKL-40 is a glycoprotein that plays role in inflammation and malignant processes. High serum YKL-40 levels are associated with short survive in cancer and chronic obstructive pulmonary disease (COPD) is another reason to increase its' level. However, limited knowledges are known in YKL-40 along with lung cancer and COPD. MATERIALS AND METHODS: One hundred patients were involved to study with lung cancer (84 men, 16 women, and median age 62). Results were compared with 30 healthy volunteers. Thirteen patients were small cell lung cancer (SCLC), 87 patients were non-small cell lung cancer (NSCLC). 62% of patients were inoperable. RESULT: Median YKL-40 level was 222.7 ± 114.1 ng/mL in patients and was 144.5 ± 105.7 ng/mL in controls (p< 0.001). Stage, tumour size, lymph node involvement and distant metastasis weren't associated with serum YKL-40 level. Above all cut-off values (133.159 and 162 ng/mL) survival was shorter (p> 0.05). Patients with COPD had worse survive above all cut-off values (p< 0.05), especially according to 133 ng/mL (p= 0.01). CONCLUSIONS: YKL-40 level is useful in lung cancer however it's not related to cell type and prognosis. It is associated with poor prognosis in lung cancer patients with COPD.

[Which factors effects patients belief and attitudes about influenza vaccination?] / Hastalarin influenza asisina karsi düsünce ve tutumlarini hangi faktörler etkiler?

INTRODUCTION: Despite its proven efficacy, vaccination rates with influenza vaccine are considerably low. This study aimed to investigate the vaccination rates with influenza-vaccine and the factors affecting attitude toward vaccination. MATERIALS AND METHODS: A questionnaire was applied to patients presenting to outpatient clinic between October 2011-January 2012. RESULT: Of these 1251 (671 F, 580 M) patients with a mean age of 47.7 ± 15.1, 61.9% had an indication for influenza-vaccination. The rate of vaccination was 33.4%. Among the vaccinated patients, the ratio of patients with an educational level of high-school or above (60.6%) was greater than that of patients with a lower educational level (39.4%) (p= 0.01). The vaccination rates were greater among those with chronic lung disease (43.6%), heart disease (21.2%), and diabetes (19.3%) (p< 0.001, p= 0.02, and p= 0.03, respectively). A multivariate regression analysis revealed that the independent variables associated with vaccination were considering the vaccine protective (OR, 2.13; CI, 1.85-4.24, p= 0.03), getting vaccinated to protect oneself (OR, 6.31; CI, 3.25-12.63, p< 0.001), getting vaccinated to protect one's family against influenza (OR, 5.42; CI, 3.11-9.54, p= 0.02), the vaccine being recommended by a physician (OR, 4.15; CI, 2.03-7.45, p< 0.001), being regularly-vaccinated (OR, 5.32; CI, 3.24-6.35, p< 0.001), and suffering from chronic lung disease (OR, 2.21; CI, 1.64-4.32, p< 0.001). The reasons of not getting vaccinated were considering the vaccine useless (OR, 2.46; CI, 0.77-3.98; p= 0.01),having concerns about side-effects (OR, 2.14; CI, 0.16-3.25; p= 0.02),and having inadequate knowledge (OR, 7.12; CI, 4.23-12.56; p< 0.001). Men, as compared to women, had a significantly greater rate of considering the vaccine useful (p< 0.001), getting vaccinated during campaigns held by workplaces (p= 0.002), and obtaining information through bills, brochures, or bulletins (p= 0.003). Patients vaccinated with the influenza-vaccine significantly more commonly consider the pneumococcal-vaccine useful (p= 0.02), and they had a significantly greater rateofvaccination with pneumococcal-vaccine (p< 0.001). CONCLUSIONS: The vaccination rate remains low. Opinions about the vaccine that had favourable effect on vaccination rate were that the vaccine was beneficial and that it would protect one's family against the disease. The unvaccinated patients had inadequate knowledge of the vaccine. Obtaining information from a physician boosts vaccination rate. Men having a greater rate of vaccination through campaigns of workplaces as well as a greater rate of being informed can be explained by a higher employment rate in men.

Prognostic significance of serum vascular endothelial growth factor and Angiopoietin-2 in patients with lung cancer.

INTRODUCTION: Vascular endothelial growth factor (VEGF) and Angiopoietin-2 (Ang-2) are major angiogenic mediators in neovascularization process. In current literature both biomarkers are discussed separately and only for non-small cell lung cancer (NSCLC). So in this study we aimed to examine them together for both cell types NSCLC and small cell lung cancer (SCLC). PATIENTS AND METHODS: 100 patients with lung cancer were enrolled to this single center study. 87 of patients were diagnosed with NSCLC including 28 adenocarcinomas and 59 squamous cell cancers and 13 were SCLC. Results were compared with 30 healthy volunteers. Pre-treatment serum VEGF and Ang-2 levels were measured by using ELISA method. RESULTS: While serum Ang-2 levels were higher in patients than healthy controls (23395 pg/mL vs. 4025 pg/mL, p< 0.001), VEGF levels didn't differ (2308 pg/mL vs. 2433 pg/mL, p> 0.05). There was no difference between cases with SCLC and NSCLC in terms of Ang-2. But serum VEGF values were significantly lower in SCLC than NSCLC and control groups. None of these mediators were correlated with cell type, tumor size, TNM staging, performance status and operability. VEGF levels were higher in patients with chronic obstructive pulmonary disease (COPD), but it was not significant. Three cut of values were determined according to sensitivity and specificity by using youden index. They were 8515.73 pg/mL (sensitivity 78%, specificity 76%), 7097 pg/mL (sensitivity 80%, specificity 70%) and 11063.48 pg/mL (sensitivity 76%, specificity 70%). Patients with SCLC had shorter survival time above cut-off values (p> 0.05). VEGF and Ang-2 showed a weak positive correlation (p= 0.1 and r= 0.638). CONCLUSION: In conclusion, serum VEGF wasn't useful to predict lung cancer, prognosis or cell type. Albeit Ang-2 was higher in patients with lung cancer without any effect on survival. Due to the heterogeneity of the studies done with serum measurement Ang-2 on tumor tissue should be more meaningful.

Pulmonary arterial hypertension and systemic sclerosis relation: a single centre experience.

AIM: In systemic sclerosis (SSc), this single-centre study aimed to define the frequency and association of pulmonary arterial hypertension (PAH), occurring either alone in SSc-PAH or together with interstitial lung disease (ILD-PH). MATERIAL-METHODS: SSc cases between the years 1990-2011 were reviewed, retrospectively. Patients' clinical, laboratory findings, Modified Rodnan Skin Score and Medsger score, 6-minute walk distance (6MWD), carbon monoxide diffusion test (DLCO), echocardiography, thorax HRCT, and right heart catheterisation findings were recorded. RESULTS: One hundred and forty-one cases (F/M:124/17, diffuse cutaneous SSc (DcSSc)/limited cutaneous SSc (LcSSc): 84/57) were included in the study with the mean age of 52.70±15.17 years and disease duration of 107.07±99.44 months. PaO2, FEV1 and FVC were lower in DcSSc (p<0.05) as compared to LcSSc, but DLCO and 6MWD did not differ significantly, between the two forms. Ground glass opacity (64.7%) and interlobular septal thickening (58.8%) were the most frequent findings on HRCT of such subjects. PAH was detected in 34 subjects (24.1%). Seven of them had SSc associated PAH (SSc-PAH) and 27 ILD-PH. Both frequencies were similar between DcSSc and LcSSc. Mean sPAP was higher in SSc-PAH. CONCLUSION: PAH was observed in approximately one fourth of patients; therefore advanced cardio-pulmonary investigation should be routinely performed in the SSc patients' management.

The evaluation of arsenic and cadmium levels in biological samples of cases with lung cancer.

INTRODUCTION: Chronic exposure to the toxic metals plays an important role among the causes of lung cancer beside of smoking. We aimed to evaluate the association between the histopathologic type of lung cancer and arsenic and cadmium levels in biological samples. MATERIALS AND METHODS: This study in a single center was conducted through the years 2009-2013, including 72 patients with lung cancer, within a prospective study design. Biological samples (whole blood, scalp hair, urine) of subjects obtained before the treatment, and arsenic and cadmium levels were analyzed by atomic absorption spectrophotometer. The characteristics of lung cancer cases and metal levels were compared statistically (power: 0.74). RESULTS: Fifty six (77.8%) of patients were non-small cell lung cancer (NSCLC), 16 (22.2%) were small cell lung cancer (SCLC) in 72 study subjects (7 F/65 M, mean age= 62.2 ± 8.7 years). According to TNM staging, 27 of NSCLC were stage IV, 14 of SCLC were extensive disease. In blood, scalp hair and urine samples of cases, mean arsenic levels were 23.1 ± 9.2 µg/L, 0.6 ± 0.3 µg/g and 3.6 ± 1.9 µg/L, while cadmium levels were 1.2 ± 0.8 µg/L, 0.3 ± 0.1 µg/L and 2.8 ± 1.6 µg/L, respectively. A significant negative correlation was found between blood and urine arsenic levels (r= -0.350; p= 0.025). Blood and hair cadmium levels were also significant positive correlated (r= -0.371; p= 0.017). Both of metal levels except of urine arsenic were higher in NSCLC patients than SCLC, without any statistical significance. No significance relation was found in terms of TNM staging and mortality (p> 0.05). CONCLUSION: Any difference was observed between the arsenic and cadmium levels measured in biological samples and histopathological type, staging and mortality of patients with lung cancer in this study. We thought that further studies are needed.

The risk factors for late failure of non-invasive mechanical ventilation in acute hypercapnic respiratory failure.

INTRODUCTION: Non-invasive mechanical ventilation provides early improvement in most of the patients with acute hypercapnic respiratory failure. The aim of our study was to determine the risk factors for late failure of non-invasive mechanical ventilation in patients with acute hypercapnic respiratory failure. MATERIALS AND METHODS: Ninety three patients were prospectively evaluated. Non-invasive mechanical ventilation was accepted to be successful if the patient was discharged from the hospital without the need for intubation (group 1) and to be late failure if a deterioration occurred after an initial improvement of blood gases tension and general conditions (group 2). RESULTS: Non-invasive mechanical ventilation was successful in 62 (66.7%) patients. In 25 (26.9%) patients a late failure was observed. There was no difference between groups 1 and 2 in terms of pretreatment pH, PaCO2 and PaO2/FiO2. However, serum C-reactive protein level, Acute Physiology and Chronic Health Evaluation II (APACHE II) score and frequency of bronchiectasis and pneumonia were significantly higher and serum albumin level, Glasgow Coma Score, cough strength and compliance to non-invasive mechanical ventilation were significantly lower in group 2. CONCLUSION: The pretreatment high APACHE II Score and C-reactive protein level, low Glasgow Coma Score, albumin level, cough strength, bad compliance to non-invasive mechanical ventilation, the presence of bronchiectasis and pneumonia and absence of significance improvement in PaO2/FiO2 after treatment were determined as risk factors for non-invasive mechanical ventilation late failure.

Anxiety and Depression Symptoms of Family Members of Intensive Care Unit Patients: A Prospective Observational Study and the Lived Experiences of the Family Members.

Background The aim of this study is to investigate the factors affecting symptoms of anxiety and depression in the family members of critically ill patients. Methods This prospective cohort study was conducted in an adult tertiary care mixed medical-surgical intensive care unit (ICU) at a tertiary-level teaching hospital. The symptoms of anxiety and depression of first-degree adult relatives were evaluated with the Hospital Anxiety and Depression Scale. Four family members were interviewed and asked about their experiences during the ICU process. Results A total of 84 patients and their family members were included in the study. The symptoms of anxiety were present in 44/84 (52.4%), and depression was present in 57/84 (67.9%) family members. A nasogastric tube was found to be related to anxiety ( p = 0.005) and depressive symptoms ( p = 0.002). The family members of the patients with an acute developed illness had 3.9 (95% confidence interval [CI]: 1.4-10.9) times the odds of having the symptoms of anxiety and 6.2 (95% CI: 1.7-21.7) times the odds of having the symptoms of depression than the family members of the patients with an illness developed on a chronic basis. The family members of the patients who died in the ICU had 5.0 (95% CI: 1.0-24.5) times the odds of being depressed than the patients discharged from the ICU. All interviewees stated having difficulty understanding and remembering what was told. The common feelings of all the interviewees were desperation and fear. Conclusions Awareness of the emotional stress of family members can help develop interventions and attitudes to alleviate symptom burden.

The Impact of CoronaVac Vaccination on 28-day Mortality Rate of Critically Ill Patients with COVID-19 in Türkiye.

Background: Vaccines against coronavirus disease-19 (COVID-19) have been effective in preventing symptomatic diseases, hospitalizations, and intensive care unit (ICU) admissions. However, data regarding the effectiveness of COVID-19 vaccines in reducing mortality among critically ill patients with COVID-19 remains unclear. Aims: To determine the vaccination status and investigate the impact of the COVID-19 vaccine on the 28-day mortality in critically ill patients with COVID-19. Study Design: Multicenter prospective observational clinical study. Methods: This study was conducted in 60 hospitals with ICUs managing critically ill patients with COVID-19. Patients aged ≥ 18 years with confirmed COVID-19 who were admitted to the ICU were included. The present study had two phases. The first phase was designed as a one-day point prevalence study, and demographic and clinical findings were evaluated. In the second phase, the 28-day mortality was evaluated. Results: As of August 11, 2021, 921 patients were enrolled in the study. The mean age of the patients was 65.42 ± 16.74 years, and 48.6% (n = 448) were female. Among the critically ill patients with COVID-19, 52.6% (n = 484) were unvaccinated, 7.7% (n = 71) were incompletely vaccinated, and 39.8% (n = 366) were fully vaccinated. A subgroup analysis of 817 patients who were unvaccinated (n = 484) or who had received two doses of the CoronaVac vaccine (n = 333) was performed. The 28-day mortality rate was 56.8% (n = 275) and 57.4% (n = 191) in the unvaccinated and two-dose CoronaVac groups, respectively. The 28-day mortality was associated with age, hypertension, the number of comorbidities, type of respiratory support, and APACHE II and sequential organ failure assessment scores (p < 0.05). The odds ratio for the 28-day mortality among those who had received two doses of CoronaVac was 0.591 (95% confidence interval: 0.413-0.848) (p = 0.004). Conclusion: Vaccination with at least two doses of CoronaVac within six months significantly decreased mortality in vaccinated patients than in unvaccinated patients.