Epidemiological analysis of the victims with crush syndrome in earthquakes of southeastern Turkey.

BACKGROUND: Each year, millions face natural disasters, encountering mass fatalities and severe medical issues such as crush injuries and crush syndrome. Crush syndrome, marked by acute kidney injury (AKI) and hyperkalemia, correlates with mortality. This study focuses on presenting epidemiological data on kidney disease resulting from the February 6, 2023 earthquakes centered in Kahramanmaras. METHODS: This retrospective analysis included patients diagnosed with crush syndrome after the 2023 Kahramanmaras earthquakes, treated in regional hospitals or referred elsewhere in Turkey. Patient data were documented using the web-based system developed by the Turkish Nephrology Association Renal Disaster Working Group. RESULTS: Of the 1024 analyzed patients from 46 centers, 515 (50.3%) were women. The mean age was 41 ± 16 years, with a median duration of 12 h under rubble, and the median presentation time to the first health facility was 4 h after extrication from the rubble. Upon admission, 79.8% received intravenous fluid therapy, all potassium-free. Initial serum creatinine, K+, and creatinine kinase levels averaged 2.59 ± 2 mg/dl, 5.1 ± 1 mmol/L 38,305 ± 54,303 U/L, respectively. Intensive care unit (ICU) admissions were 53.6%, with mean hospital and ICU stays of 20 and 11 days, respectively. Compartment syndrome occurred in 40.8% of patients, with 75.8% undergoing fasciotomy. Acute kidney injury developed in 67.9% of patients, with 70.3% undergoing hemodialysis, totaling 3016 sessions on 488 patients. The overall in-hospital mortality rate was 9.8%. CONCLUSION: Earthquakes have a significant impact on kidney health. Although our study indicates some progress compared to previous earthquake responses, there remains a crucial need for drills emphasizing post-earthquake initial response, fluid-electrolyte balance management, and emergency dialysis protocols.

Predicting Mortality of COVID-19 in Kidney Transplant Recipients With Developed Scores.

OBJECTIVES: COVID-19 is a recently discovered ß-subtype coronavirus infection due to SARS-CoV-2. Approximately 20% of COVID-19 patients have moderate to severe clinical manifestations and 5% progress to critical illness. Kidney transplant patients form a special group. In our study, we aimed to evaluate the success of the COVID-gram score and systemic immuno-inflammation index score in predicting the risk of mortality during hospitalization among kidney transplant patients. MATERIALS AND METHODS: Our study included 50 kidney transplant patients with positive real-time reverse transcription polymerase chain reaction COVID-19 tests between March 2020 and March 2021. Risk scores were calculated using baseline clinical data collected retrospectively from the patient cohort. RESULTS: The mean age was 54.3 ± 10.2. The mortality rate was 12%. When we compared the COVID-gram and systemic immuno-inflammation index scores between survivors and nonsurvivors, we did not find any difference. CONCLUSIONS: Kidney and other solid-organ transplant patients are at greater risk of infection and mortality than other groups. Accurate risk-predicting tools are imperative for managing the COVID-19 pandemic with limited health resources.

Relationship between symptom burden and dialysis adequacy in patients with chronic kidney disease undergoing hemodialysis.

OBJECTIVE: The aim of this study was to reveal the relationship between hemodialysis (HD) adequacy and dialysis symptom index (DSI) in patients with end-stage kidney disease (ESKD). METHODS: This prospective study included 92 ESKD patients who underwent HD three times a week. Data including sex, age, education status, marital status, economic status, employment status, dependency status, type of vascular access, and duration of HD were recorded. Biochemical and hematological analyses were carried out. Dialysis adequacy was assessed based on clinical and biochemical analysis. The DSI was used to evaluate the emotional and physical symptoms of HD patients. RESULTS: Of the patients, 55 were males and 37 were females, with a mean age of 59.95±14.9 years. The median duration of HD was 60.0 months (interquartile range: 20.8-103.5). The mean DSI score was 54.35±26.0, with a significantly higher score in female patients (p<0.001). There was a significant correlation between DSI and increasing age (p<0.05). The single pool Kt/V (spKt/V) ratio of HD patients with AVF access was significantly higher, and the mean DSI was significantly lower than that of those receiving HD with a central venous catheter (p<0.001). The mean DSI score was significantly higher in patients with a spKt/V ratio of <1.2 than those with a spKt/V ratio of ≥1.2 (p<0.001). In multivariate regression analysis using biochemical parameters, the spKt/V ratio was a significant and independent predictor of DSI scores (R2=0.64, p<0.001). In addition, a significant and independent relationship was found between DSI and gender, age, and economic status in the regression analysis (R2=0.36, p<0.001). CONCLUSION: Dialysis adequacy is an independent predictor of DSI. If an adequate dialysis dose is ensured to be delivered, symptom burden may dramatically decrease.

Learning Curve for Temporary Hemodialysis Catheter Placement.

BACKGROUND: Training is essential for the safe and uncomplicated placement of hemodialysis catheters. This study explores the learning curve of this procedure. METHODS: In this prospective study, 60 patients who needed emergency hemodialysis without vascular access were included. All catheters were placed under ultrasound guidance. One nephrologist was included in each two groups, one to be consisted of a junior, and one to be consisted of a senior. Learning curves were created using the cumulative total methodology and receiver operating characteristic curve analyses. RESULTS: The patients' mean age was 67.92 ± 14.23 years. The mean catheter insertion time of the senior nephrologist was significantly shorter than that of the junior. According to cumulative total analysis, the junior group's maximum learning point overlaps with patient 22. When the confidence intervals of the study durations of both groups were examined, they overlapped in the 95% confidence interval starting from the 19th patient. When the mean catheter insertion time of the senior and the mean of the last 12 patients of the junior were compared, there was no significant difference between them (F = 15.827, P = .092). The receiver operating characteristic curve analysis showed a cutoff value of 320 seconds for the junior group compared with the senior group, indicating an overlap in case 22 for the junior nephrologist. CONCLUSION: This study suggests that 22 catheter insertions under the supervision of a senior nephrologist are needed to complete the learning curve for a junior nephrologist. If the number of nephrologists at the center is limited, safe catheter insertion may be allowed after 19 insertions.

Evaluation of risk scores as predictors of mortality and hospital length of stay for older COVID-19 patients.

Objective: This study was intended to research the sensitivity of the Charlson Comorbidity Index (CCI), COVID-GRAM, and MuLBSTA risk scores for hospital length of stay (LOS) and mortality in older patients hospitalized with coronavirus disease 2019 (COVID-19). Methods: A total of 217 patients (119 women) were included in the study. The first clinical signs, comorbidities, laboratory and radiology findings, and hospital LOS were recorded for each patient. The CCI, COVID-GRAM, and MuLBSTA risk scores were calculated, and their sensitivities for hospital LOS and mortality were evaluated using receiver operating characteristic (ROC) curve analysis. Results: Of the hospitalized patients, 59 (27.2%) were followed in the intensive care unit, and mortality developed in 44 (20.3%). The CCI positively correlated with COVID-GRAM and MuLBSTA scores (P < 0.001). COVID-GRAM and MuLBSTA results correlated with LOS and mortality (P < 0.001). According to the ROC curve analysis, the cutoff points for mortality were 5 for CCI, 169 for COVID-GRAM, and 9 for MuLBSTA. Conclusion: Older patients with comorbidities are the major risk group for severe COVID-19. COVID-GRAM and MuLBSTA scores appear to be sensitive and reliable mortality indicators for these patients.

Predictive Value of Systemic Immune-inflammation Index in Determining Mortality in COVID-19 Patients.

Aim: The aim of this study was to evaluate whether systemic immune-inflammation index (SII) could predict mortality in patients with novel coronavirus 2019 (COVID-19) disease. Methods: This two-center, retrospective study included a total of 191 patients with confirmed diagnosis of COVID-19 via nucleic acid test (NAT). The SII was calculated based on the complete blood parameters (neutrophil × platelet/lymphocyte) during hospitalization. The relationship between the SII and other inflammatory markers and mortality was investigated. Results: The mortality rate was 18.3%. The mean age was 54.32±17.95 years. The most common symptoms were fever (70.7%) and dry cough (61.3%), while 8 patients (4.2%) were asymptomatic. The most common comorbidities were hypertension (37.7%), diabetes (23.0%), chronic renal failure (14.7%), and heart failure (7.9%) which all significantly increased the mortality rate (p<0.001). There was a highly positive correlation between the SII and polymorphonuclear leukocyte (PNL), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) (r=0.754, p<0.001; r=0.812, p<0.001; r=0.841, p<0.001, respectively), while a moderate, positive correlation was found between the SII and C-reactive protein (CRP) (r=0.439, p<0.001). There was a significant correlation between the SII and mortality (U=1,357, p<0.001). The cut-off value of SII was 618.8 (area under the curve=0.751, p<0.001) with 80.0% sensitivity and 61.5% specificity. A cut-off value of >618.8 was associated with a 4.68-fold higher mortality. Conclusion: Similar to NLR and PLR, the SII is a proinflammatory marker of systemic inflammation and can be effectively used in independent predicting COVID-19 mortality.

Relationship between diabetic polyneuropathy, serum visfatin, and oxidative stress biomarkers.

BACKGROUND: Diabetic polyneuropathy is a very common complication of diabetes. Numerous studies are available in terms of pathogenesis. But examination methods with low reliability are still not standardized and generally time consuming. High-sensitive, easy-to-access methods are expected. Biochemical markers are one of the subjects of research. We aimed to discover a potential biomarker that can be used for this purpose in patients with diabetes who have not yet developed symptoms of neuropathy. AIM: To determine the place and availability of visfatin and thiol-disulfide homeostasis in this disorder. METHODS: A total of 392 patients with type 2 diabetes mellitus were included in the study. The polyneuropathy clinical signs were evaluated with the Subjective Peripheral Neuropathy Screen Questionnaire and Michigan Neuropathy Screening Instrument questionnaire and examination. The biochemical parameters, oxidative stress markers, visfatin, and thiol-disulfide homeostasis were analyzed and correlated with each other and clinical signs. RESULTS: Subjective Peripheral Neuropathy Screen Questionnaire and Michigan Neuropathy Screening Instrument questionnaire with examination scores were correlated with each other and diabetes duration (P < 0.005). Neuropathy related symptoms were present in 20.7% of the patients, but neuropathy related findings were observed in 43.9% of the patients. Serum glucose, glycated hemoglobin, and visfatin were positively correlated with each other. Also, these parameters were positively correlated with the total oxidative stress index. Total and native thiol was positively correlated with total antioxidant status and negatively with oxidant status. Inversely thiol-disulfide positively correlated with higher glucose and oxidant status and negatively with total antioxidant status (P < 0.005). There was no correlation between visfatin and thiol-disulphide (P = 0.092, r = 0.086). However, a significant negative correlation was observed between visfatin and total with native thiol (P < 0.005, r = -0.338), (P < 0.005, r = -0.448). CONCLUSION: Diagnosis of neuropathy is one of the issues studied in patients with diabetes. Visfatin and thiol-disulfide balance were analyzed for the first time in this study with inspiring results.