Determinants of 30-day mortality in elderly patients admitted to a cardiovascular surgery intensive care unit.

BACKGROUND: This study aims to identify the factors influencing 30-day morbidity and mortality in patients aged 65 and older undergoing cardiovascular surgery. METHODS: Data from 360 patients who underwent cardiac surgery between January 2012 and August 2021 in the Cardiovascular Surgery Intensive Care Unit (CVS ICU) were analyzed. Patients were categorized into two groups: "mortality+" (33 patients) and "mortality-" (327 patients). Factors influencing mortality, including preoperative, intraoperative, and postoperative risk factors, complications, and outcomes, were assessed. RESULTS: Significant differences were observed between the two groups in factors affecting mortality, including extubation time, ICU stay duration, blood transfusion, surgical reexploration, aortic clamp duration, glomerular filtration rate (GFR), blood urea nitrogen (BUN), creatinine, hemoglobin A1c (HbA1c) levels, and the lowest systolic blood pressure during the first 24 hours in the ICU (p<0.05). The "mortality+" group had longer extubation times and ICU stays, required more blood transfusions, and had higher BUN-creatinine ratios, but lower systolic blood pressures, GFR, and HbA1c levels. Mortality was also higher in patients needing noradrenaline infusions and those who underwent reoperation for bleeding (p<0.05). CONCLUSION: By optimizing preoperative renal function, minimizing extubation time, shortening ICU stays, and carefully managing blood transfusions, surgical reexplorations, aortic clamp duration, and HbA1c levels, we believe that the mortality rate can be reduced in elderly patients. Key strategies include shortening aortic clamp times, reducing perioperative blood transfusions, and ensuring effective bleeding control.

Investigation of serum ischemic-modified albumin, galectin-3, paraoxonase-1, and myeloperoxidase activity levels in patients with acute brucellosis.

OBJECTIVES: Infection remains current as an important discussion topic in the etiological factors of atherosclerosis. Ischemic-modified albumin (IMA), galectin-3 (gal-3), paraoxonase-1 (PON-1), and myeloperoxidase (MPO) are biomolecules that play an important role in the pathogenesis of atherosclerosis. Our aim is to investigate serum IMA, gal-3, PON-1, and MPO activity in acute brucellosis infection. MATERIALS AND METHODS: Forty patients with acute brucellosis and 40 healthy individuals were included in the study. Serum IMA, gal-3, PON-1, and MPO activity were analyzed by the ELISA method. RESULTS: In acute brucellosis infection, serum gal-3, IMA, and MPO activities were found to be significantly increased compared to the control group, and PON-1 activity was found to be significantly decreased compared to the control group (p < 0.001). There was a positive correlation between serum IMA, and MPO activity (r = 0.707 p = 0.000) and a negative correlation (r = -0.943, p = 0.000) between PON-1 activity. There was a positive correlation between serum gal-3 and MPO activity (r = 0.683, p = 0.000) and IMA level (r = 0.927, p = 0.000) and a negative correlation between PON-1 activity (r = -0.951, p = 0.000).Conclusion, it was found that serum gal-3, IMA levels and MPO activity increased, while PON-1 activity decreased. These results showed that the oxidant-anti-oxidant balance is impaired in acute brucellosis infection. In addition, these results indicate that brucella infection may be increase the risk of atherosclerosis. Further studies are needed to support our findings.

Deaths related to drowning in Antalya, an important tourism center in the Mediterranean region: A 10-year retrospective study.

Objectives: Drowning is one of the most common causes of accidental deaths in all age groups. This study aims to compare the sociodemographic data, scene of incident findings, clinical characteristics, and autopsy findings of Turkish and foreign victims of drowning in Antalya, one of the most popular global holiday destinations. Study Design: This study is the most extensive case series of drowning in Turkey. Methods: A retrospective examination was made of 7775 autopsies, of which 692 (8.9%) were identified as drowning cases. Results: Almost half of the cases were elderly males of foreign nationality, with a chronic disease and high alcohol consumption, who were found wearing swimming clothes and had died accidentally, mostly in the sea or swimming pools. The majority of Turkish victims were male children and adolescents, found wearing normal daily clothes, who died from a fall or while performing high-risk activities, such as jumping from height. Most of these cases died at the scene of the incident due to an accident or suicide. Conclusions: Such incidences of deaths in Antalya could be reduced with the implementation of precautions, with adjustments made according to the increased risks and, particularly, the mobility of the older age group. Significantly, chronic disease is an important risk factor in cases of drowning.

Deaths associated with electric shock injuries in children and adults: A 10-year retrospective examination in Sanliurfa, Southeast Turkey (2012-2022).

Electric shock injuries (EIs) have high rates of morbidity and mortality in both children and adults. The aim of this study was to examine autopsy cases resulting from EIs and to compare pediatric and adult groups with respect to sociodemographic data, clinical characteristics, location of the incident, electricity entry-exit wound characteristics, current direction, pathological effects of the electric shocks on the body, and cause of death. A total of 8075 autopsies conducted between 2012 and 2022 were retrospectively examined. Sanliurfa is a city in the southeast of Turkey with the highest birth rate in the country. Of 123 cases of death resulting from EIs in Sanliurfa, 58 (47.2%) were children (age < 18 years). In the majority of children (81%), a low-voltage injury resulted from a domestic appliance while the children were playing at home in a rural area. In the vast majority of adults, a high-voltage injury (HVI) resulted from a workplace accident due to working with HVI materials in an area outside the home. The manner of death was accidental in all the electric shock injuries. The electricity entry and exit wounds formed as a result of EIs had similar characteristics in both children and adults, with no significant difference identified. In the province of Sanliurfa, Turkey, which borders Syria and where the main occupation is agricultural activities, there is a need to increase electrical safety precautions within the home, educate parents, and increase electrical safety conditions and worker education in the workplace.

Infant Electrocution Due to Smartphone Charge Cable-A Hidden Public Health Risk.

ABSTRACT: The report examines the autopsy and scene of accident findings of a 9-month-old male infant who died from electric shock when he bit a telephone charge cable plugged into a 3-socket extension lead.At the time of the incident, the infant's father was working outside and his mother had gone to the bathroom, leaving the infant alone in the sitting room. The infant crawled across the floor, reached a telephone charge cable that was plugged into a 3-socket extension lead, and bit the end of the cable. He was found lying motionless on the floor, holding the cable in his hand. He was sent to center for the medicolegal autopsy, during which burns and electric shock entry wounds were found on his mouth, tongue, and right hand. Histopathological examination of the samples taken from the wounds garnered findings consistent with electric shock and thermal effect.This article presents findings of an electric shock entry wound on the tongue, which is rarely seen as the result of a domestic accident. Education is needed to increase awareness among parents about accidents in the home involving children and to encourage preference for electrical products that have shown high success in safety tests.

Increased visinin-like protein-1, YKL-40, lipocalin-2, and IL-23 levels in patients with migraine.

BACKGROUND: Migraine is a type of primary headache caused by changes in the trigeminal system and has been reported to be associated with neurovascular inflammation of cerebral and extracerebral vessels. OBJECTIVE: It is known that inflammation is an important process in the pathogenesis of migraine. It has been shown that the molecules of visinin-like protein 1 (Vilip-1), YKL-40, lipocalin-2 and interleukin (IL)-23 play a role in the inflammatory process. Our aim is to investigate the role of this molecule in the metabolic pathway of migraine disease. METHODS: Fifty migraine patients with and without aura in the interictal period were included in the study. Vilip-1, YKL-40, lipocalin-2, and IL-23 levels were measured by ELISA method. RESULTS: Serum vilip-1, YKL-40, lipocalin-2, and IL-23 levels were found to be significantly higher in migraine patients compared to the control group. We found that this molecule increased significantly in migraine subgroups compared to the control group (p < 0.001). A positive significant correlation was found between vilip-1 level and YKL-40 and lipocalin-2 levels in migraine patients. In addition, a positive correlation was observed between visual analogue scale score, number of days with pain and vilip-1 level (p < 0.01). The results of our study showed that activation of inflammatory mediators may play a role in the pathogenesis of migraine disease. In addition, our study is valuable in that inflammatory molecules are high in the interictal period and these biomarkers have never been analyzed in migraine patients. However, we still believe that larger studies are needed to explain the role of vilip-1, YKL-40, lipocalin-2, and IL-23 in the molecular mechanism of migraine disease.

An experimental rat model of electric shock injury with isolated electric shock and water conduction: the histopathological changes on the skin and internal organs and the effect on biochemical parameters.

It is difficult to determine the cause of death in electric shock injuries when no trace can be determined on the skin, and this is accepted as a reason for negative autopsy. We aimed to determine useful parameters in the definition of the cause of deaths associated with electric shock and particularly those formed with water conduction. This study used a total of 42 rats, applied with fatal electric shock formed of isolated electric shock at 220 V and with water conduction. The serum NT-ProBNP and H-FABP levels were examined together with histopathological changes in the brain, cerebellum, brainstem, heart, liver and skin and the Bax, caspase-3 and HSP-60 antibody status in these tissues. A statistically significant difference was determined between the groups in respect of the serum H-FABP values and the immunohistochemical staining of the samples taken from the organs. In conclusion, this study is the first in literature with an experimental model of electric shock with water conduction. Using immunohistochemical and biochemical markers in deaths associated with isolated electric shock and electric shock with water conduction, the results of this study can contribute to the clarification of one of the reasons for negative autopsy in forensic medicine.

A 9-year retrospective review of lightning deaths from the Eastern Anatolian Region of Turkey.

In this study, deaths from lightning strikes in Eastern Turkey revealed distinct patterns in lifestyle and physical injury. Farmers, sailors, and those engaged in outdoor sports are all at risk of being struck by lightning. Death from a lightning strike is associated with cardiovascular and central nervous system damage. This study examines cases of autopsies that were performed on bodies that had suffered a lightning strike, including sociodemographic data, burns on the body, injured regions, histopathological findings, and causes of death. This retrospective evaluation included 17 cases. The cases comprised 88.2% males and 11.8% females, with a mean age of 41.5 years. The person's occupation was farmer in 29.4% of the cases and shepherd in 70.6%. Their deaths occurred most frequently in the summer months. Deaths associated with lightning strikes are more frequent in east of Turkey than in other regions, as agriculture and livestock are common sources of income. The majority of the victims among the cases were males working outside because of their occupations. Histopathologically, subarachnoid fresh bleeding was seen in five cases, subpleural fresh bleeding in the lungs in five cases, and interlobular rupture in the lungs in three cases. Deaths associated with lightning strikes have been correlated with a low level of education in this subject. This study is the largest case study of deaths associated with lightning strikes in Turkey.

Cerebrospinal fluid levels of sortilin-1, lipocalin-2, autotaxin, decorin and interleukin-33 in patients with idiopathic intracranial hypertension.

BACKGROUND: Idiopathic intracranial hypertension (IIH) is characterized by increased cerebrospinal fluid (CSF) pressure of unknown cause. It has been suggested that the inflammatory process plays a role in the pathophysiology of the disease. Sortilin-1, lipocalin-2, autotaxin, decorin, and interleukin-33 (IL-33) are among the factors involved in inflammatory processes. OBJECTIVE: To investigate the CSF levels of sortilin-1, lipocalin-2, autotaxin, decorin, and IL-33 in patients with IIH. METHODS: A total of 24 IIH patients and 21 healthy controls were included in the study. Demographic characteristics of the patients and of the control group as well as CSF pressures were evaluated. Sortilin-1, lipocalin-2, autotaxin, decorin and IL-33 levels in the CSF were measured. RESULTS: The CSF levels lipocalin-2, sortilin-1, autotaxin, IL-33 and CSF pressure were significantly higher in the patients group compared with the control group (p < 0.001). Decorin levels were reduced in patients (p < 0.05). There was no correlation between the autotaxin and IL-33 levels and age, gender, CSF pressure, and body mass index. The results of our study showed that inflammatory activation plays an important role in the development of the pathophysiology of IIH. In addition, the fact that the markers used in our study have never been studied in the etiopathogenesis of IIH is important in explaining the molecular mechanism of this disease. CONCLUSION: Studies are needed to evaluate the role of these cytokines in the pathophysiology of the disease. It is necessary to evaluate the effects of these molecules on this process.

ANTECEDENTES: A hipertensão intracraniana idiopática (HII) é caracterizada pelo aumento da pressão do líquido cefalorraquidiano (LCR) de causa desconhecida. Tem sido sugerido que o processo inflamatório desempenha um papel na fisiopatologia da doença. Sortilina-1, lipocalina-2, autotaxina, decorina e interleucina-33 (IL-33) estão entre os fatores envolvidos nos processos inflamatórios. OBJETIVO: Investigar os níveis de sortilina-1, lipocalina-2, autotaxina, decorina e IL-33 no LCR de pacientes com HII. MéTODOS: Um total de 24 pacientes com HII e 21 controles saudáveis foram incluídos no estudo. Foram avaliadas as características demográficas dos pacientes e do grupo controle, bem como as pressões liquóricas. Os níveis de sortilina-1, lipocalina-2, autotaxina, decorina e IL-33 no LCR foram medidos. RESULTADOS: Os níveis no líquido cefalorraquidiano lipocalina-2, sortilina-1, autotaxina, IL-33 e pressão liquórica foram significativamente maiores no grupo de pacientes em comparação com o grupo controle (p < 0,001). Os níveis de decorina foram reduzidos nos pacientes (p < 0,05). Não houve correlação entre os níveis de autotaxina e IL-33 e idade, sexo, pressão liquórica e índice de massa corporal. Os resultados do nosso estudo mostraram que a ativação inflamatória desempenha um papel importante no desenvolvimento da fisiopatologia da HII. Além disso, o fato de os marcadores utilizados em nosso estudo nunca terem sido estudados na etiopatogenia da HII é importante para explicar o mecanismo molecular dessa doença. CONCLUSãO: Estudos são necessários para avaliar o papel dessas citocinas na fisiopatologia da doença. É necessário avaliar os efeitos dessas moléculas nesse processo.

Cerebrospinal fluid levels of sortilin-1, lipocalin-2, autotaxin, decorin and interleukin-33 in patients with idiopathic intracranial hypertension / Níveis de sortilina-1, lipocalina-2, autotaxina, decorina e interleucina-33 no líquido cefalorraquidiano em pacientes com hipertensão intracraniana idiopática

Abstract Background Idiopathic intracranial hypertension (IIH) is characterized by increased cerebrospinal fluid (CSF) pressure of unknown cause. It has been suggested that the inflammatory process plays a role in the pathophysiology of the disease. Sortilin-1, lipocalin-2, autotaxin, decorin, and interleukin-33 (IL-33) are among the factors involved in inflammatory processes. Objective To investigate the CSF levels of sortilin-1, lipocalin-2, autotaxin, decorin, and IL-33 in patients with IIH. Methods A total of 24 IIH patients and 21 healthy controls were included in the study. Demographic characteristics of the patients and of the control group as well as CSF pressures were evaluated. Sortilin-1, lipocalin-2, autotaxin, decorin and IL-33 levels in the CSF were measured. Results The CSF levels lipocalin-2, sortilin-1, autotaxin, IL-33 and CSF pressure were significantly higher in the patients group compared with the control group (p < 0.001). Decorin levels were reduced in patients (p < 0.05). There was no correlation between the autotaxin and IL-33 levels and age, gender, CSF pressure, and body mass index. The results of our study showed that inflammatory activation plays an important role in the development of the pathophysiology of IIH. In addition, the fact that the markers used in our study have never been studied in the etiopathogenesis of IIH is important in explaining the molecular mechanism of this disease. Conclusion Studies are needed to evaluate the role of these cytokines in the pathophysiology of the disease. It is necessary to evaluate the effects of these molecules on this process.

Resumo Antecedentes A hipertensão intracraniana idiopática (HII) é caracterizada pelo aumento da pressão do líquido cefalorraquidiano (LCR) de causa desconhecida. Tem sido sugerido que o processo inflamatório desempenha um papel na fisiopatologia da doença. Sortilina-1, lipocalina-2, autotaxina, decorina e interleucina-33 (IL-33) estão entre os fatores envolvidos nos processos inflamatórios. Objetivo Investigar os níveis de sortilina-1, lipocalina-2, autotaxina, decorina e IL-33 no LCR de pacientes com HII. Métodos Um total de 24 pacientes com HII e 21 controles saudáveis foram incluídos no estudo. Foram avaliadas as características demográficas dos pacientes e do grupo controle, bem como as pressões liquóricas. Os níveis de sortilina-1, lipocalina-2, autotaxina, decorina e IL-33 no LCR foram medidos. Resultados Os níveis no líquido cefalorraquidiano lipocalina-2, sortilina-1, autotaxina, IL-33 e pressão liquórica foram significativamente maiores no grupo de pacientes em comparação com o grupo controle (p < 0,001). Os níveis de decorina foram reduzidos nos pacientes (p < 0,05). Não houve correlação entre os níveis de autotaxina e IL-33 e idade, sexo, pressão liquórica e índice de massa corporal. Os resultados do nosso estudo mostraram que a ativação inflamatória desempenha um papel importante no desenvolvimento da fisiopatologia da HII. Além disso, o fato de os marcadores utilizados em nosso estudo nunca terem sido estudados na etiopatogenia da HII é importante para explicar o mecanismo molecular dessa doença. Conclusão Estudos são necessários para avaliar o papel dessas citocinas na fisiopatologia da doença. É necessário avaliar os efeitos dessas moléculas nesse processo

An examination of the sociodemographic and psychiatric characteristics of children who have suffered penetrative and non-penetrative sexual abuse in Malatya, Eastern Turkey.

Penetrative and nonpenetrative sexual abuse can cause short- and long-term psychiatric problems in victims. This study aimed to examine the sociodemographic characteristics and psychiatric diseases of children in Malatya, eastern Turkey, according to whether the abuse was penetrative or nonpenetrative. A retrospective examination was conducted on the records of 115 cases of sexual abuse that had been referred to judicial authorities from January 1, 2012-July 30, 2019. The subjects were evaluated by a committee formed of 5-7 separate specialized department faculty members. It was determined that 51.3% (n = 59) of the cases had suffered nonpenetrative sexual abuse, and 48.7% (n = 56) had suffered penetrative sexual abuse. The majority of the perpetrators were known to the child from their close environment. A psychiatric diagnosis was made by the committee in 20.3% (n = 12) of the nonpenetrative cases and in 42.9% (n = 24) of the penetrative cases. There was a significant difference between penetrative and nonpenetrative sexual abuse in terms of psychiatric diagnoses. Of the cases of penetrative sexual abuse, 87.5% (n = 14) had attempted suicide. As a result, early diagnosis of sexual abuse, which has devastating effects on mental health in the early and late periods before it penetrates, can reduce the devastating effects on the child. For this reason, it is crucial for doctors, psychologists, social workers, and teachers who work with children to be informed about this issue.

Prognostic Nutritional Index and CRP, age, platelet count, albumin level score in predicting mortality and intensive care unit admission for COVID-19.

Aim: In our study, we investigated the efficiency of the prognostic nutritional index (PNI) score and the CRP, age, platelet count, albumin level (CAPA) score predicting mortality and intensive care unit (ICU) admission in COVID-19 disease. Materials & methods: PNI and CAPA score of patients confirmed with COVID-19 calculated by using the complete blood count and biochemical parameters at admission to the hospital, in predicting the COVID-19-associated mortality and ICU admission were analyzed. Results: PNI and CAPA scores in predicting mortality were detected as AUC: 0.67 (p < 0.001), AUC: 0.71 (p < 0.001), respectively. For predicting ICU admission AUC was 0.66 (p < 0.001), AUC was 0.77 (p < 0.001), respectively. Conclusion: PNI and CAPA scores are effective scores in COVID-19, with CAPA score being better in predicting mortality and ICU admission.

Lay abstract The COVID-19 pandemic is a global health problem that affects all societies. In order to deal with this urgent situation, the rapid spread of the disease in outbreaks requires categorizing patients according to risk group and regulating follow-up and use of resources accordingly. Effective, practical and inexpensive biomarkers are needed. We present to you the CAPA score calculated from CRP, age, platelet count, albumin levels, which is an effective score in predicting mortality and ICU admission in COVID-19.

Elevation of Serum Transaminase Levels Due to Favipiravir Use in the Treatment of COVID-19.

BACKGROUND AND AIMS: Favipiravir is a ribonucleic acid (RNA)-dependent RNA polymerase (RdRP) inhibitor antiviral agent used in the treatment of coronavirus disease-2019 (COVID-19). In this study, we investigated the changes in serum transaminase levels of patients and the relationship between serum transaminase elevation with mortality in patients who were hospitalized with the diagnosis of COVID-19 and received favipiravir treatment. MATERIALS AND METHODS: 454 patients who received favipiravir and 113 patients who did not receive favipiravir were evaluated. Serum transaminase levels of the patients were compared at baseline and after five days of treatment, and the relationship between serum transaminase elevation and mortality was investigated. RESULTS: No significant aspartate aminotransferase (AST) or alanine aminotransferase (ALT) elevation was detected due to favipiravir treatment. AST elevation was found, respectively, as 133 (29.3%), 32 (28.3%) (p=0.100), ALT elevation as 112 (24.7%), 35 (29.3%) (p=0.100) in the groups receiving and not receiving favipiravir. High AST level was found as a risk factor for mortality in all patient groups (p=0.008). CONCLUSIONS: There was no statistically significant elevation in serum transaminase levels due to favipiravir use in patients hospitalized for COVID-19. A high level of AST is a significant risk factor to show mortality and intensive care unit (ICU) admission in patients with COVID-19.

Shaken baby syndrome resulting in death: a case series.

BACKGROUND: The aim of this study was to raise the awareness of all healthcare personnel, primarily Emergency Department physicians, forensic physicians, and paediatricians about cases of shaken baby syndrome (SBS), which can be difficult to diagnose, require a high level of suspicion in diagnosis and there is a high likelihood of missed diagnosis. METHODS: A retrospective examination was made of 3400 forensic cases applied with autopsy between 2012 and 2018 to the Forensic Medicine Institution of Malatya Group Directorate. RESULTS: Of the total cases, 113 were aged < 2 years and head trauma was determined in 35. Eight cases were determined as SBS. Of the 8 cases that resulted in death, 75% were male and the mean age was 8.3 months. The trauma had been perpetrated by the father in 50% of cases. There was a history of seizure in 67.5% of the infants and 75% were taken to the Emergency Department with cardiopulmonary arrest. Subdural hematoma and subarachnoid hemorrhage were determined in 37.5% of the cases, subdural hematoma, subarachnoid hemorrhage and intracranial hemorrhage in 50%, and epidural hemorrhage and subarachnoid hemorrhage in 12.5%. In the microscopic examination of the medulla spinalis, focal subdural fresh bleeding was seen in 50% of cases. Bleeding around the optic nerves was determined in 37.5% of cases bilaterally and in 37.5% unilaterally. Retinal hemorrhage was determined in all the cases, which was bilateral in 75%. CONCLUSIONS: The actual worldwide incidence of SBS is not known, and in Turkey, it is thought to be much higher than has been determined. The most important reason for this is thought to be that the diagnosis of child abuse is difficult and physicians do not have a sufficient level of knowledge.

A Case Series of Imported Malaria Caused by Plasmodium falciparum in Kayseri and Review of Literature.

Malaria is a major worldwide public health problem. In the last years, no domestic cases of malaria have been detected and cases of imported malaria exist only in Turkey. In this study, clinical and laboratory findings of five Plasmodium falciparum (P. falciparum) malaria patients who were admitted to the emergency department between January 2013 and December 2015 were retrospectively presented. One of the patients was an African student, and the other patients had a history of travelling to Africa. Ring formation was observed when Giemsa staining was performed on the blood smears of all patients, and in three patients, P. falciparum was also detected using multiplex polymerase chain reaction (PCR) (Bio-Rad, United States of America). P. falciparum was not detected by PCR in the other two patients. Malaria should be primarily considered in febrile patients who have a history of travelling to endemic regions, and peripheral blood smears should definitely be examined.