Evaluation of antifungal and disinfectant-resistant Candida species isolated from hospital wastewater.

The present study aims to examine the in vitro antifungal susceptibility patterns of Candida species isolated from hospital wastewater, and the efficacy of widely used disinfectants (sodium hypochlorite and benzalkonium chloride) against planktonic and biofilm cells were assessed. Susceptibility testing demonstrated that the two azoles were more effective against C. albicans than non-albicans isolates. When we determine the efficiency of disinfectants against the planktonic cells, benzalkonium chloride did not show any activity in all the studied strains under tested conditions except C. albicans-1. However, sodium hypochlorite showed ≥ 4 log10 killing in viable cells for different contact times. On the other hand, while 0.1% and 1% concentrations of benzalkonium chloride showed fungicidal activity against biofilm cells, sodium hypochlorite at 1% only demonstrated fungicidal activity. Those results showed that surface water is a possible transmission path for fungi in the investigated hospital region and may be a health risk, especially for the immunocompromised host.

Performance and microbial shift during acidification of a real pharmaceutical wastewater by using an anaerobic sequencing batch reactor (AnSBR).

In this study, a lab-scale anaerobic sequencing batch reactor (AnSBR) was used for the acidification of a pharmaceutical wastewater sourced from etodolac chemical synthesis tanks. The effects of the organic loading rate (OLR), and etodolac and sulfate concentrations on the acidification rate and microbial community in AnSBR were investigated at 35 °C with a hydraulic retention time (HRT) of 37 h, a pH of 5, and OLRs up to 5.2 kgCOD/m3·day. The AnSBR accomplished a 60% acidification ratio and 50-60% etodolac removal at OLRs up to 2.6 kgCOD/m3·day. However, at OLR = 3.9 kgCOD/m3·day, acidification was not achieved due to sulfite inhibition; pre-ozonation was applied to overcome this sulfite inhibition. Although etodolac and COD removals were improved, the wastewater was not successfully acidified. Real-time polymerase chain reaction (Q-PCR) and fluorescent in situ hybridization (FISH) analyses revealed that acidification was inhibited by the dominance of sulfate reducing bacteria (SRB) over acidification bacteria in the AnSBR. However, increasing the OLR to 5.2 kgCOD/m3·day led to toxicity stress in the SRB due to increased sulfite concentrations. Sulfate load fundamentally affected acidification process and microbial community composition. The presence of etodolac with concentration up to 56 mg/L did not have a significant effect on VFA production and the microbial community.

Effect of iron ions (Fe2+, Fe3+) on the formation and structure of aerobic granular sludge.

Aerobic granulation is a promising technology for wastewater treatment, but problems regarding its formation and stability need to be solved. Divalent metal ions, especially Ca2+, Mg2+ and Mn2+, have been demonstrated to play an important role in the process of aerobic granulation. Here, we studied whether iron ions can affect aerobic granulation. Granular sludge formed without iron ion addition (<0.02 mg Fe2+ L-1) was fluffy and had a finger-type structure and filamentous out-growth. The addition of iron ions to concentrations of 1 and 10 mg Fe2+ L-1 repressed the finger-type structure and filamentous out-growth. The results show that chemical precipitation in the granules with iron ion addition was higher than that in the granules without ferrous addition. The amount of precipitates was higher inside the granules than outside. This study demonstrates that iron ions (Fe2+/Fe3+) increase the size and stability of aerobic granular sludge but do not affect the granulation time, which is the time that the first granular sludge is observed. The study shows that aerobic granular sludge technology can be confidently applied to actual wastewater containing a high concentration of iron compounds.

Characterization and toxicity of hospital wastewaters in Turkey.

The aim of the study was to present first preliminary characterization of Turkish hospital wastewaters, their environmental risk, and a method for toxicity assessment. The hospital wastewater samples were collected from two of the largest medical faculty hospitals and a training and research hospital in Istanbul, Turkey. The samples from the selected hospitals were taken as grab samples on March 2014. Overall, 55 substances including pharmaceuticals and their metabolites, pesticides, and corrosion inhibitors were analyzed in all hospital wastewaters. Analysis of toxicity and the antibiotic resistance bacteria were investigated in addition to the chemical analysis in the wastewater of one hospital. Hazard quotients (HQs) and toxic units (TUs) were calculated as basis of the environmental risk assessment. Fourteen pharmaceuticals in hospital wastewater (HWW) were classified as "high risk" with HQ > 10. HQHWW values higher than 100 were determined for five antibiotics and one analgesic, namely, ofloxacin, clarithromycin, ciprofloxacin, sulfapyridine, trimethoprim, and diclofenac. Ofloxacin with an HQHWW of 9090 was observed to be the most hazardous compound. HQ and TU values of the wastewater treatment plant (WWTP) effluent dropped significantly due to dilution in the sewer. Further elimination by biological degradation or adsorption was observed only in some cases. However, the decreased HQWWTPeffluent values do not the change environmental load significantly. Therefore, advanced treatment processes should be applied to remove the persistent compounds. In combination with the results on antibiotic resistance, we would prefer on-site treatment of hospital wastewater. Toxicological assessment was performed using cytotoxic and mutagenic screening tests. The results of the Ames assay showed that the native hospital wastewaters had strongly mutagenic activity with a ≤10-fold increase relative to negative controls. The mutagenic potentials of the samples were generally concentration and metabolic activation dependent. Multiple antibiotic resistances were demonstrated with the tested isolates to ciprofloxacin, trimethoprim, and ceftazidime. This study demonstrates that the hospital wastewaters in Istanbul exhibit strong environmental and toxicological risks, as well as high multiple drug resistance to commonly used antibiotics.

Improving the performance of an aerobic membrane bioreactor (MBR) treating pharmaceutical wastewater with powdered activated carbon (PAC) addition.

In this study, the effects of organic loading rate (OLR) and the addition of powdered activated carbon (PAC) on the performance and membrane fouling of MBR were conducted to treat real pharmaceutical process wastewater. Over 145 days of operation, the MBR system was operated at OLRs ranging from 1 to 2 kg COD m(-3) day(-1) without sludge wasting. The addition of PAC provided an improvement in the flux, despite an increase in the OLR:PAC ratio. The results demonstrated that the hybrid PAC-MBR system maintained a reduced amount of membrane fouling and steadily increased the removal performance of etodolac. PAC addition reduced the deposition of extracellular polymeric substance and organic matter on the membrane surface and resulted an increase in COD removal even at higher OLRs with low PAC addition. Membrane fouling mechanisms were investigated using combined adsorption fouling models. Modified fouling index values and normalized mass transfer coefficient values indicated that predominant fouling mechanism was cake adsorption.

Model-based evaluation of simultaneous nitrification and denitrification in aerobic granular sludge systems.

A lab-scale granular sludge sequencing batch reactor (G-SBR) system was operated using synthetic wastewater. The total nitrogen removal efficiency of 85% was obtained together with the achievement of complete total phosphorus removal with average granule diameter of 400 µm. Dual-step nitrification and denitrification model with fixed biofilm thickness was used for performance analysis. The denitrification mode only contributed to TN removal with 25% which can be calculated with process stoichiometry. The remaining nitrogen removal could be explained by simulating simultaneous nitrification and denitrification which was responsible for 75% denitrification during aerobic period. In addition, low NO3- concentration at the beginning of the fill period provided advantage for securing a prolonged anaerobic period for enhanced biological phosphorus removal (EBPR). The model parameters of boundary layer thickness (zBL = 50 µm) and half-saturation of O2 for nitrite-oxidizing bacteria (KO2,NOB = 0.5 gO2/m3) were tuned to fit NO2 and NO3 profiles in SBR cycle.

Mucormycosis in a pediatric population: a review of 20 cases from southern Turkey.

BACKGROUND: Mucormycosis is a fatal invasive fungal infection seen most often in patients with compromised defense mechanisms. The aim of this article was to review the data of pediatric mucor in the South of Turkey. METHODS: Twenty pediatric cases with biopsy proven mucormycosis were reported, between January 2007 through January 2017. Data were extracted from the medical charts of patients retrospectively. RESULTS: Underlying conditions were hematological malignancy (75%), in whom 93% had acute leukemia, aplastic anemia (15%), diabetes mellitus (5%) and other malignancies (5%). The main sites of infection were sinus (85%); alone (29.4%) or with cerebral (17.6%), and orbital involvement (17.6%). Pulmonary involvement was reported in 11 patients (55%), two of them had the alone form and nine cases were associated with nasal sinus involvement. Disseminated mucormycosis was documented in 45%. Fever and pain/swelling of organs were the most commonly encountered signs and symptoms. Treatment compromised of am-photericin B monotherapy in five patients. All patients except one received liposomal formu-lations (LAmB). A combination of surgery and antifungal therapy was performed in 75%. Crude survival was 55%; among 15 cases treated with a combination of surgery and antifun-gal therapy, survival rate was 8/15 (53%). The overall mortality rate was high in patients diagnosed with disseminated infection (100%). CONCLUSIONS: Mucormycosis in pediatric cases requires a high index of suspicion and urgent evaluation of clinical samples. Surgical debridement should be considered when feasible. Initial medical therapy should include an amphotericin preparation with or step-down to posaconazole.

Detailed characterization, antibiotic resistance and seasonal variation of hospital wastewater.

This study investigates the presence of the different classes of micro-pollutants such as pharmaceutical active compounds (PhACs) (20 antibiotics, 8 analgesics and anti-inflammatories, 5 cytostatic agents, 7 ß-blockers, 4 lipid regulators, 13 psychiatrics, 1 antidiabetic, 1 receptor antagonist, 1 local anaesthetic, 1 antihypertensive and their 5 metabolites), hormones (8 compounds), X-ray contrast agents (6 compounds), benzotriazoles (3 compounds) and pesticides (6 compounds), and antibiotic resistance in hospital wastewater (HWW) of a medical faculty in Istanbul, Turkey. In addition, the seasonal variations of the selected PhACs and X-ray contrast agents and antibiotic resistance were evaluated for 2 years in a total of eight samples. In the PhACs, sulfamethoxazole and its metabolite (4 N-acethyl-sulfamethoxazole) in the antibiotic group and paracetamol in the analgesic and anti-inflammatory group were found at 100% of frequency and the highest concentrations as 35, 43 and 210 µg/L, respectively. The mean concentrations of psychiatric compounds were found less than 0.25 µg/L except carbamazepine (1.36 µg/L). Bisphenol A in hormone group had the highest concentration up to 14 µg/L. In the hormone group compounds, 17-α-Ethinylestradiol and 17-ß-Estradiol were detected at lower mean concentrations of 0.2 and 0.05 µg/L, respectively. 1H-benzotriazole had the highest concentration with the mean concentration of 24.8 µg/L in benzotriazole group compounds. The compounds in X-ray contrast agents group were noted as compounds detected at the highest concentration in HWW up to 3000 µg/L. Antibiotic resistance against azithromycin, clindamycin and trimethoprim-sulfamethoxazole antibiotics was observed around 50% in the winter period. The seasonal variation was detected for the most of the investigated PhACs, especially in antibiotic group which was in line with those significant differences in antibiotic resistance rates in the studied antibiotics between winter and summer seasons.

Right ventricular adaptations along with left ventricular remodeling in older athletes.

BACKGROUND: Afterload changes and anatomic interaction between the ventricles cause right ventricle (RV) adaptation along with left ventricle (LV) remodeling. This study was designed to evaluate RV adaptations along with LV remodeling and to determine the effect of aging on both ventricles in a population of older athletes. METHODS: Echocardiographic characteristics of 48 endurance trained older athletes were examined by tissue Doppler imaging (TDI) and integrated backscatter (IBS). RESULTS: Mean LV mass index was calculated as 107.8+/-17.0 g/m(2). Twenty-two athletes were > 55 years old. Age was found to be a risk factor for diastolic dysfunction regarding lateral TDI velocities (E(m) < A(m)) (r = 0.385, P < 0.001). RV long-axis (LAX) diameters were associated with LA volumes and LV masses (r = 0.380, P < 0.01 and r = 0.307, P < 0.05). RV LAX diameters were correlated with RV TDI E-wave (r =-0.285, P < 0.05), RV LAX average, and peak IBS values (r = 0.36, P < 0.05 and r = 0.348, P < 0.05). CONCLUSIONS: TDI and IBS are applicable methods to evaluate the relationship between the two ventricles in athletes' heart. Increased RV LAX IBS values indicate increased LV mass and LA volume as a result of RV changes along with LV remodeling. Our data suggest that RV TDI E-wave and average RV IBS values reflect cardiac adaptations of both RV and LV in older athletes.

A sequencing batch reactor system for high-level biological nitrogen and phosphorus removal from abattoir wastewater.

A sequencing batch reactor (SBR) system is demonstrated to biologically remove nitrogen, phosphorus and chemical oxygen demand (COD) to very low levels from abattoir wastewater. Each 6 h cycle contained three anoxic/anaerobic and aerobic sub-cycles with wastewater fed at the beginning of each anoxic/anaerobic period. The step-feed strategy was applied to avoid high-level build-up of nitrate or nitrite during nitrification, and therefore to facilitate the creation of anaerobic conditions required for biological phosphorus removal. A high degree removal of total phosphorus (>98%), total nitrogen (>97%) and total COD (>95%) was consistently and reliably achieved after a 3-month start-up period. The concentrations of total phosphate and inorganic nitrogen in the effluent were consistently lower than 0.2 mg P l(-1) and 8 mg N l(-1), respectively. Fluorescence in situ hybridization revealed that the sludge was enriched in Accumulibacter spp. (20-40%), a known polyphosphate accumulating organism, whereas the known glycogen accumulating organisms were almost absent. The SBR received two streams of abattoir wastewater, namely the effluent from a full-scale anaerobic pond (75%) and the effluent from a lab-scale high-rate pre-fermentor (25%), both receiving raw abattoir wastewater as feed. The pond effluent contained approximately 250 mg N l(-1) total nitrogen and 40 mg P l(-1) of total phosphorus, but relatively low levels of soluble COD (around 500 mg l(-1)). The high-rate lab-scale pre-fermentor, operated at 37 degrees C and with a sludge retention time of 1 day, proved to be a cheap and effective method for providing supplementary volatile fatty acids allowing for high-degree of biological nutrient removal from abattoir wastewater.

Simultaneous nitrification, denitrification, and phosphorus removal from nutrient-rich industrial wastewater using granular sludge.

The biological removal of nitrogen and phosphorus from nutrient-rich abattoir wastewater using granular sludge has been investigated. A lab-scale sequencing batch reactor, seeded with granular sludge developed using synthetic wastewater, was operated for 13 months under alternating anaerobic and aerobic conditions. It is demonstrated that the granules could be sustained and indeed further developed with the use of abattoir wastewater. The organic, nitrogen, and phosphorus loading rates applied were 2.7 gCOD L(-1) day(-1), 0.43 gN L(-1) day(-1), and 0.06 gP L(-1) day(-1), respectively. The removal efficiency of soluble COD, soluble nitrogen and soluble phosphorus were 85%, 93%, and 89%, respectively. However, the high suspended solids in the effluent limited the overall removal efficiency to 68%, 86%, and 74% for total COD, TN, and TP, respectively. This good nutrient removal was achieved through the process known as simultaneous nitrification, denitrification, and phosphorus removal, likely facilitated by the presence of large anoxic zones in the center of the granules. The removal of nitrogen was likely via nitrite optimizing the use of the limited COD available in the wastewater. Accumulibacter spp. were found to be responsible for most of the denitrification, further reducing the COD requirement for nitrogen and phosphorus removal. Mineral precipitation was evaluated and was not found to significantly contribute to the overall nutrient removal. It is also shown that the minimum HRT in a granular sludge system is not governed by the sludge settleability, as is the case with floccular sludge systems, but likely by the limitations associated with the transfer of substrates in granules.

The association of nocturnal serum melatonin levels with major depression in patients with acute multiple sclerosis.

The association of nocturnal serum melatonin levels was investigated in acute multiple sclerosis (MS) patients with major depression (MD). The sample comprised 13 patients with MD and 12 with no psychiatric disorders admitted to our clinic due to acute MS attacks. Psychiatric evaluation was performed with the Structured Clinical Interview for DSM-IV (SCD-I). The level of depressive symptoms was assessed with the Beck Depression Scale (BDS). Blood samples were taken from the patients to determine melatonin level at 03.30 h and 10.00 h before steroid treatment started. Melatonin levels were determined using the ELISA test. Nocturnal serum melatonin levels (21.2+/-17.1 pg/ml) of the patients with MD were significantly lower than those (51.5+/-18.3 pg/ml) of the patients without MD. A significant negative correlation was found between BDS scores and nocturnal serum melatonin levels. These findings suggest that a melatonin deficiency may be among the factors involved in the occurrence of depression in MS patients.

Effects of high-concentration influent suspended solids on aerobic granulation in pilot-scale sequencing batch reactors treating real domestic wastewater.

The aim of this study was to investigate the effect of high-influent-concentration suspended solids (SS) on the cultivation, structure and long-term stability of aerobic granular sludge (AGS). Cultivation and long-term stability of AGS were monitored in two pilot-scale sequencing batch reactors fed with raw (R1) and settled (R2) domestic wastewater, representing high and medium SS content, respectively. The real domestic wastewater had high chemical oxygen demand (COD) content (1100 ±â€¯270 mg COD L-1). Aerobic granular sludge was cultivated in 44 days (R1) and 25 days (R2) under the conditions of high settling velocity (18 m h-1) and high organic loading rate (OLR) (2.1-2.4 kg COD m3 day). The AGS in both reactors had similar structural properties during long-term operation and remained structurally and functionally stable during the last five months of operation. Comparative evaluation of the results indicated that the high influent SS content of the real domestic wastewater had a positive influence on maintaining significantly lower SVI30 and relatively lower effluent SS concentration. Moreover, a higher influent SS content resulted in smaller mature granules during the stable period. Microbial community analyses helped to understand the aerobic granular sludge structure and showed that the sludge retention time and OLR affected the granular sludge population. The high influent SS increased biomass detachment from the granular sludge surface and caused wash-out of some bacteria colonizing the exterior of the granular sludge.

Effectiveness of an alternating aerobic, anoxic/anaerobic strategy for maintaining biomass activity of BNR sludge during long-term starvation.

The effectiveness of an aerobic, anoxic/anaerobic strategy for maintaining the activity of activated sludge performing biological nitrogen and phosphorus removal during long-term starvation is investigated. A lab-scale sequencing batch reactor (SBR) treating abattoir wastewater and achieving high-levels (>95%) of nitrogen, phosphorus and COD removal was used. The reactor was put twice into a so-called "sleeping mode" for a period of 5-6 weeks when the abattoir, where the wastewater was sourced, was closed down for annual maintenance. The "sleeping mode" operation consisted of 15 min aeration in a 6 h SBR cycle. The sludge was allowed to settle in the remaining time of the cycle. The decay rates for ammonia oxidising bacteria (AOB) and nitrite oxidising bacteria (NOB) were determined to be 0.017 and 0.004 d(-1), respectively. These decay rates correlated well with AOB and NOB population quantified using molecular techniques (FISH). There was negligible phosphate accumulation in the reactor during the first 1-2 weeks of starvation, which was followed by a linear net release of phosphate in the remaining 4-5 weeks at a very slow rate of 1-2 mgP gVSS(-1)d(-1). A sudden decrease in the aerobic activities of polyphosphate accumulating organisms (PAOs), observed via anaerobic/aerobic batch tests, occurred after 2 weeks of starvation. This correlated with a dramatic increase of several metal ions in the liquid phase. The underlying reasons are not clear. A resuscitation period with a gradual increase of the wastewater load was applied during the re-startup of the reactor after both "sleeping mode" periods. Each time, the performance of the reactor in terms of nitrogen and phosphorus removal fully recovered in 4 days.

Effect of diet oils on lipid levels of the brain of rats.

The effects of sunflower oil, olive oil, margarine, soybean oil and butter on cholesterol and triglyceride levels were investigated in the brain of rats. Rats were fed with a diet containing 15% of the oils for a period of 8 weeks. The rats were then decapitated, brain samples were removed, homogenized and cholesterol and TG levels were measured. Brain cholesterol and Triglycerides levels of all animals receiving different oils were significantly higher according to the contol except TG level of animals receiving margarine. Brain cholesterol levels of the vegetable oils were statistically higher than those receiving saturated oil. Thus, cholesterol level of the rats fed with olive oil group was significantly higher than that of the other groups but those receiving sunflower oil group and Triglycerides level of the animals receiving olive oil was significantly higher than that of the other groups except animal supplemented with soybean oil. Thus, it is concluded that brain lipid levels of rats are differently effected by various oils and mechanism of which needs to be investigated.

Effects of ferrous iron on the performance and microbial community in aerobic granular sludge in relation to nutrient removal.

Lab-scale experiments were conducted to investigate the effects of ferrous iron on nutrient removal performance and variations in the microbial community inside aerobic granular sludge for 408 days. Two reactors were simultaneously operated, one without added ferrous iron (SBR1), and one with 10 mg Fe2+  L-1 of added ferrous iron (SBR2). A total of 1 mg Fe2+  L-1 of added ferrous iron was applied to SBR1 starting from the 191st day to observe the resulting variations in the nutrient removal performance and the microbial community. The results show that ammonia-oxidizing bacteria (AOB) could not oxidize ammonia due to a lack of iron compounds, but they could survive in the aerobic granular sludge. Limited ferrous iron addition encouraged nitrification. Enhanced biological phosphorus removal (EBPR) from both reactors could not be maintained regardless of the amount of ferrous iron that was applied. EBPR was established in both reactors when the concentration of mixed liquor suspended solid (MLSS) and the percentage of Accumulibacteria increased. A total of 10 mg Fe2+  L-1 of added ferrous iron had a relatively adverse effect on the growth of AOB species compared to 1 mg Fe2+  L-1 of added ferrous iron, but it encouraged the growth of Nitrospira sp. and Accumulibacteria, which requires further study. It could be said that the compact and stable structure of aerobic granular sludge preserved AOB and NOB from Fe-deficient conditions, and wash-out during the disintegration period. © 2017 American Institute of Chemical Engineers Biotechnol. Prog., 33:716-725, 2017.

Management of Left Ventricular Free Wall Rupture Associated with Acute Myocardial Infarction.

Left ventricular free wall rupture is one of the mechanical complications of acute myocardial infarction and it may result in cardiac tamponade as well as limiting itself by forming a pseudoaneurysm. In this report, a case of left ventricular free wall rupture and pseudoaneurysm that developed during the course of posterior myocardial infarction has been presented. Left ventricular free wall rupture and pseudoaneurysm were identified by three-dimensional transthoracic echocardiography and surgically repaired at a late stage.

[The determination of the factors impacting on in-hospital mortality in patients with acute heart failure in a tertiary referral center]. / Tersiyer bir merkezde akut kalp yetersizlikli hastalarda hastane içi mortaliteye etkili faktörlerin belirlenmesi.

OBJECTIVE: Despite impressive advances in therapeutics in the last years, acute heart failure (AHF) remains a major cause of cardiovascular morbidity and mortality. Patients hospitalized because of heart failure (HF), irrespective of left ventricular systolic function, represent a high-risk population with limited short-term prognosis. A substantial component of HF-related mortality occurs during a hospital stay. In this study, we aimed to determine the factors impacting on in-hospital mortality in patients with AHF. METHODS: During a 15-month period (December 2005-March 2007), 85 consecutive patients with (mean age: 64+/-8 years, male: 54%) an episode of AHF were included in this study. The effect of demographic, clinical, electrocardiographic, and echocardiographic characteristics, laboratory findings on in-hospital mortality were evaluated retrospectively. RESULTS: Of 85 patients 24.7% of patients had new-onset HF. Coronary artery disease (61%) was the most common underlying disease. The 44.7% of patients had hypertension, 37.6% had diabetes mellitus, 21% had chronic renal failure and 16.4% had chronic obstructive pulmonary disease. Left ventricular ejection fraction was 35+/-7%. In-hospital mortality rate was found as 11.7% (10 patients). The major cause of mortality was the progression of HF to cardiogenic shock in 60% of deaths. In comparison with surviving patients in terms of the clinical, demographic, electrocardiographic, and laboratory characteristics and left and right ventricular functions, patients died during hospitalization had higher blood urea nitrogen (45+/-20 mg/dl vs. 36+/-12 mg/dl, p=0.04), higher creatinine level (2.2+/-0.8 mg/dl vs. 1.1+/-0.5 mg/dl, p=0.001), and wider QRS duration (130+/-13 ms vs. 116+/-18 ms, p=0.04) whereas they had lower plasma sodium level (128+/-5 mmol/l vs. 135+/-9 mmol/l, p=0.02) and systolic blood pressure (p=0.01). Logistic regression analysis revealed that plasma creatinine level (OR 1.5, 95% CI 1.2 to 2.1, p=0.01), blood urea nitrogen (OR 2.1, 95% CI 1.8 to 3.1, p=0.001), plasma sodium level (OR 1.3, 95% CI 1.1 to 1.7, p=0.02), and systolic blood pressure (OR 2.2, 95% CI 1.9 to 2.8, p=0.01) were the independent predictors of in-hospital mortality. CONCLUSION: In-hospital mortality increases in patients who had lower systolic blood pressure, lower plasma sodium level, and renal dysfunction on admission.