Penetrating thoracic trauma accounts for 20–25% of all deaths due to trauma in the first four decades of life. About 33% of deaths from thoracic trauma occur due to penetrating trauma. In an autopsy study that enrolled 1178 trauma patients, 82% of the patients with tracheobronchial injuries died at the incidence site. In another study, 30% of those who could be transferred to the hospital died. This review aimed to revisit penetrating thoracic trauma with respect to complications and the strategies for airway management. While the risk of death in injuries with a sharp object is normally 1–8%, it reaches 25–28% when the cardiac box is included, and still, most of the patients are lost before they can come to the hospital. The consequences and management of penetrating thoracic trauma are mainly dependent on the extent of the injury to internal organs, as well as on the skill of the clinicians, airway obstruction, respiratory failure, and bleeding. Chest computed tomography (CT) is better than chest radiography in diagnosing the main bronchus or lobe/segment rupture. However, with the use of multi-channel multi-detector CT, the sensitivity of CT imaging has increased to 94% in the diagnosis of tracheobronchial injuries. While standard orotracheal intubation is sufficient in 75% of the patients, flexible bronchoscopy, intubation through the open wound or tracheostomy is required for airway provision in the rest. Clinical suspicion is the first diagnostic tool in a patient with penetrating airway trauma, and early treatment with multidisciplinary teamwork is life-saving.

The Relationship Between CRP/Albumin Ratio and In-Hospital Mortality in Intensive Care Patients: A Retrospective Observational Study - Istanbul Medical Journal

Objective: Fragmented QRS complex (fQRS) is associated with increased morbidity and mortality, sudden cardiac death, and recurrent cardiovascular events. The role of coronary artery bypass grafting (CABG) in the primary treatment of acute myocardial infarction remains controversial. In this study, we aimed to assess the predictive value of fQRS in-hospital mortality among acute Impact of fragmented QRS on in-hospital mortality in emergency coronary artery bypass grafting for STEMI: A retrospective analysis patients undergoing emergency CABG for primary revascularization. Patients and Methods: Between 2010 and 2020, we retrospectively included 99 consecutive STEMI patients who were not eligible for primary percutaneous intervention and required emergency CABG. The study population was divided into two groups: survivors and non-survivors. We compared the two groups regarding demographic, clinical, and operative characteristics. Results: fQRS was identified as an independent predictor of in-hospital mortality (p = 0.037). Additionally, left ventricular ejection fraction (LVEF) was an independent predictor of in-hospital mortality (p = 0.028). Glomerular filtration rate (GFR), glucose levels, and Killip class ≥ III were significantly associated with in-hospital mortality (p = 0.002), (p = 0.001) and (p < 0.001). Conclusion: fQRS emerged as an independent predictor of in-hospital mortality among patients undergoing emergency CABG for primary revascularization in cases of STEMI.

BACKGROUND Hip fractures in geriatric patients carry high morbidity and mortality due to advanced age, frailty, and multiple comorbidities. Accurate preoperative risk assessment is therefore essential. The hemoglobin-albumin-lymphocyte-platelet (HALP) score and prognostic nutritional index (PNI) are emerging immunonutritional biomarkers reflecting inflammatory and nutritional status. This study aimed to evaluate and compare the prognostic value of preoperative HALP and PNI scores for predicting 6-month mortality and postoperative complications in elderly hip fracture patients. MATERIAL AND METHODS This retrospective cohort included 549 patients aged≥³65 years who underwent surgical repair of proximal femoral fractures between January 2021 and July 2024. Demographic characteristics, comorbidities, fracture type, and preoperative laboratory data were analyzed. HALP and PNI scores were calculated from admission blood tests. Independent predictors of 6-month all-cause mortality were identified using Cox regression, and receiver-operating characteristic (ROC) analysis determined optimal cut-off values. RESULTS The mean age was 78±9 years, and 51.9% were female. Six-month mortality was 16.4%. Non-survivors had significantly lower HALP and PNI scores (P<0.001). In multivariate Cox analysis, coronary artery disease (HR 2.57, 95% CI 1.66-4.00), postoperative complications (HR 3.97, 95% CI 2.57-6.15), and lower HALP levels (HR 3.11, 95% CI 1.19-8.13) were independently associated with mortality. Additionally, ROC analysis identified a HALP cut-off value of 0.176 for predicting mortality. CONCLUSIONS The HALP score showed modest prognostic value for 6-month mortality and can complement established clinical predictors. Its use in preoperative evaluation could help identify higher-risk patients, but its discriminatory ability should be interpreted with caution.

Objective: To assess blood transfusion decisions in blood losses using a continuous total haemoglobin (SpHb) and non-invasive haemoglobin (Hb) device.Study Design: Double-blinded randomised controlled trial. Place and Duration of Study: Marmara University Hospital, Istanbul, Turkey, from March 2018 to December 2019.Methodology: One hundred and twenty adult patients scheduled for elective major surgery and expected to experience a blood loss greater than 20% of their total blood volume were divided into two groups. These groups were compared for bleeding management with conventional blood gas sampling (Group Hb, the control group) according to Hb monitoring versus SpHb measurement (Group SpHb, the study group).Results: In the postoperative measurement, there were fewer red blood cells (RBC) in the SpHb group than in the Hb group (p=0.020). There was a greater change in the amount of RBC from the perioperative to the postoperative period in the SpHb group compared to the Hb group (p<0.001). Postoperative Hb levels of patients in the intensive care unit (ICU) were higher in the SpHb group than in the Hb group (p<0.05).Conclusion: SpHb can provide effective patient blood management in cases of major surgery. It does not cause a delay in the decision of blood transfusion during surgery.