Prognostic significance of low basal serum creatinine levels in internal intensive care unit patients.

OBJECTIVE: This study aimed to show the relationship between low creatinine level and mortality in the internal Intensive Care Unit (ICU) based on the view that there may be a relationship between low creatinine level and mortality in patients admitted to the ICU. PATIENTS AND METHODS: This retrospective, single center study was performed in the ICU. Patients older than 18 years who stayed in the ICU for more than 24 hours were included in the study. Patients were evaluated for age, gender, albumin, creatinine levels and length of hospital stay in the analysis. Patients were divided into 7 groups according to serum creatinine levels: group 1: creatinine ≤ 0.4; group 2: 0.4 < creatinine ≤ 0.6; group 3: 0.6 < creatinine ≤ 0.8; group 4: 0.8 < creatinine ≤ 1.0; group 5: 1.0 < creatinine ≤ 1.2; group 6: 1.2 < creatinine ≤ 1.4; group 7: creatinine > 1.4 mg/dL. Creatinine level of 0.7-0.8 mg/dL was considered as reference and cox regression analysis was performed. RESULTS: Of 2,359 patients admitted to the ICU, 699 died (29.6%). Mortality relationship according to the accepted creatinine levels of the patients showed a U-shaped distribution, and ICU mortality increased in both low and high creatinine levels. At low creatinine levels (creatinine ≤ 0.4 mg/dl), the mortality rate was 71.4% for men and 10.7% for female (p < 0.001). Cox regression analysis showed that group 1 and group 2 increased mortality (HR: 0.721, 95% CI; 0.555-0.936, HR: 0.509, 95% CI; 0.285-0.909, respectively). CONCLUSIONS: In patients admitted to ICU, lower creatinine acceptance is associated with increased ICU mortality and reduced survival.

The effect of spinal anesthesia that is performed in sitting or right lateral position on post-spinal headache and intraocular pressure during elective cesarean section.

Background: Although spinal anesthesia can be applied in different patient positions, the most frequently used positions are sitting and lateral positions. It is known that different patient positions during spinal anesthesia have effects on hemodynamic parameters, postdural puncture headache, and intraocular pressure. Aim: The study aimed to determine the effect of spinal anesthesia performed in either sitting or right lateral position on postspinal headache and intraocular pressure during elective cesarean section. Patients and Methods: The study was a randomized controlled study of 104 eligible pregnant women scheduled to undergo elective cesarean section. The women were randomized into two groups. Spinal anesthesia was performed either in the sitting (Group S, n = 53) or the right lateral position (Group L, n = 51). Heart rate and blood pressure were recorded throughout the operation. The participants were informed and monitored for postspinal headaches. Intraocular pressure before and after the operation was measured with Icare PRO. The obtained data were statistically compared between the two groups. Results: There was no difference between the groups in terms of demographic data. Postdural puncture headache was observed in five patients in Group S and one patient in Group L (P =0.04). There was no difference between the groups in terms of intraocular pressure (P >.05). Heart rate was not significantly different between the groups; however, there was a significant difference in average blood pressure in 1, 5, 30, and 40 minutes (P <.05). The number of trials administered to patients for spinal anesthesia was significantly higher in Group L (P =0.01). Conclusion: Spinal anesthesia performed in the sitting position for cesarean section caused a higher postspinal headache than in the right lateral position, but the position did not affect intraocular pressure.

Effect of first application laboratory values on the prognosis of COVID-19 patients hospitalized in the intensive care unit.

OBJECTIVE: The aim of the study was to investigate the effect of blood values at first admission to the hospital on predicting mortality in COVID-19 patients hospitalized in the intensive care unit (ICU). PATIENTS AND METHODS: The blood parameters of 284 intensive care patients, who were diagnosed with COVID-19 via the Real-Time Polymerase Chain Reaction (RT-PCR) for SARS-CoV-2 RNA test, at first admission to the hospital, were evaluated. The contribution of these parameters to predicting mortality was analyzed. RESULTS: No significant relationship was found between complete blood count and mortality. However, it was determined that the ferritin, ALT, D-dimer, and urea levels significantly affected the mortality rates in intensive care patients. CONCLUSIONS: The ferritin, ALT, D-dimer, and urea levels of patients who were admitted to the ICU due to COVID-19, at first admission to the hospital, were significant in predicting mortality. Therefore, it is recommended that these parameters will be evaluated at the first application.

MUSCULAR HYPERTROPHY AS ATYPICAL INITIAL PRESENTATION OF HYPOTHYROIDISM.

Hypothyroidism is a common endocrine disease with characteristic symptoms and signs such as fatigue, weight gain, intolerance of cold, constipation, depression, mental slowdown and muscle cramps. Myopathic changes are observed in 30-80% of patients with hypothyroidism, but muscular hypertrophy with muscle stiffness has been reported in less than 10% of patients. Hoffmann's syndrome is a specific form of the hypothyroid-associated myopathy, rarely seen. Symptoms of this syndrome include proximal muscle weakness, hypertrophies in extremities, stiffness, muscle cramps, spontaneous muscle pain; and are associated with increased muscle enzymes. These findings can be seen at any time during hypothyroidism. Hofmann's syndrome has a very good prognosis. Its response to hormone replacement therapy is very good. Therefore, in patients with myopathy-like symptoms, considering in the differential diagnosis that the myopathy may be a reflection of hypothyroidism will facilitate the diagnosis and treatment. In this case, we aimed to present together Hashimoto thyroiditis and muscular hypertrophy, which is an atypical presentation of hypothyroidism and rarely seen in the literature, namely Hoffmann's syndrome.

Progression of multiple sclerosis is associated with exon 1 CTLA-4 gene polymorphism.

OBJECTIVES: Multiple sclerosis (MS) is a chronic demyelinating disease of the central nervous system which is widely believed to have a T-cell-mediated etiology. The cytotoxic T-lymphocyte antigen-4 (CTLA-4) antigen molecule plays a key role in the downregulation of T-cell responses. To examine the genetic association of the CTLA-4 gene locus with MS, we analyzed an exon 1 (A49G) transition. MATERIAL AND METHODS: One hundred and fifty-two MS patients and 154 controls were examined. The A/G transition was genotyped by a polymerase chain reaction followed by labeling with a SNaPshot kit and detection using a capillary genetic analyzer. RESULTS: The genotype, allele and phenotype frequencies did not differ significantly between MS patients and controls. Those MS patients with AA and AG genotypes had 4.36 times greater risk of progressing from the relapsing-remitting to the secondary progressive form of the disease than those with the GG genotype. CONCLUSION: The results of our study indicate that CTLA-4 (A49G) exon 1 polymorphism is associated with MS progression.