Background: Although the main target of SARS-CoV-2 is the respiratory system, in some patients, it may affect multiple organ systems, leading to multi-organ failure. Acute kidney injury (AKI) remains one of the most frequent and clinically significant complications of severe COVID-19, with clinical importance extending beyond the acute phase due to its association with long-term renal outcomes and persistent morbidity. The incidence of AKI is particularly high among patients admitted to the intensive care unit (ICU), where its development has been consistently associated with prolonged hospitalization and increased mortality. The primary aim of this study was to determine the incidence of COVID-19-associated AKI, identify factors related to its development and severity, and evaluate mortality as a clinical outcome. Methods: Data from 238 COVID-19 patients monitored in the Intensive Care Unit of Ankara University Ibni Sina Hospital (ISH-ICU) between 1 January 2021 and 1 January 2022 were retrospectively reviewed. Patients were divided into two groups according to the presence of AKI. Those with AKI were staged according to KDIGO criteria (stages 1–2–3). Demographic characteristics, comorbidities, disease severity scores, laboratory parameters, and mortality outcomes were analyzed and compared between groups. Results: AKI was identified in 54.6% of patients. Of the patients with AKI, 32 (13.4%) had stage 1, 25 (10.5%) had stage 2, and 73 (30.7%) had stage 3 AKI. Thirteen patients (5.5%) had already developed AKI at ICU admission. AKI developed at a median of 11 days after symptom onset and 3 days after ICU admission. Advanced age, hypertension, cardiovascular disease, and chronic kidney disease were more frequent in patients with AKI (p < 0.001). Higher Charlson Comorbidity Index (CCI) and Acute Physiologic Assessment and Chronic Health Evaluation II (APACHE II) scores were observed in patients with stage 3 AKI. Lymphopenia and elevated levels of D-dimer, ferritin, IL-6, CRP, and procalcitonin were significantly higher in patients with stage 3 AKI than in patients with other AKI stages and the non-AKI group. Mortality rates were higher in patients with AKI and increased with advancing AKI stage (p < 0.001). ICU length of stay was significantly longer in the AKI group (p < 0.001). Conclusions: AKI is a common complication among critically ill patients with COVID-19 and is associated with prolonged ICU stay and higher mortality rates, particularly in advanced stages. Early identification of clinical and laboratory factors associated with AKI may support timely risk stratification and targeted management in this high-risk population.

Aim An anesthesiologist needs to have the expertise and ability to perform intubation with video-assisted approaches when conventional approaches are unsuccessful. This study compared McGrath and Truview video laryngoscopes with respect to intubation success, intubation time, and early postoperative complications, while hemodynamic changes were evaluated as secondary outcomes. Methods This retrospective observational study included 123 patients aged 18–65 years with American Society of Anesthesiologists physical status classes I–III who underwent elective surgery under general anesthesia. Patient data were obtained from preoperative assessment forms. Patients intubated using McGrath (MG) (n = 63) and Truview video laryngoscopes (TW) (n = 60) were divided into Groups MG and TW, respectively. The same premedication and anesthesia induction protocol was applied to all patients. The number of intubation attempts, intubation duration, and early postoperative complications were evaluated retrospectively. Results First-attempt endotracheal intubation was achieved in 59 patients (93.7%) in the MG group and in 51 patients (85%) in the TW group, with no significant difference between the groups. However, the duration of intubation was significantly shorter in the MG group compared with the TW group (14 vs. 36 seconds, P < .001). At least one postoperative complication occurred in 19% of patients in the McGrath group and 35% in the Truview group, indicating a statistically significant difference (P < .05). Conclusion Video laryngoscopes enhance intubation by providing ergonomic handling and better anatomical visualization. Furthermore, they improve patient comfort by minimizing early postoperative complications. In this study, McGrath video laryngoscopes were associated with shorter intubation duration and fewer early postoperative complications related to laryngoscopy and endotracheal intubation.

Glutaric acidemia type 2 (GA2), also known as multiple acyl-CoA dehydrogenase deficiency (MADD), is a rare inherited disorder of mitochondrial energy metabolism in which catabolic stress may precipitate severe metabolic decompensation. We report a 25-year-old man with childhood-diagnosed GA2/MADD who had been outside metabolic follow-up and untreated for approximately 21 years. Following a dental abscess and tooth extraction, his oral intake was markedly reduced for approximately one week. He presented with abdominal pain, vomiting, progressive abdominal distension, profound hypoglycemia, and severe high-anion-gap metabolic/lactic acidosis. An outside-hospital computed tomography scan raised concern for a possible defect in gastric antral/pyloric wall integrity, although the examination was suboptimal because oral contrast could not be administered. In the setting of hemodynamic instability, marked abdominal findings, and a presumed gastrointestinal perforation, emergency exploratory laparotomy was performed; no perforation or other intra-abdominal pathology was identified. Postoperatively, persistent life-threatening metabolic acidosis, circulatory failure, and recurrent hypoglycemia prompted intensive care management with continuous veno-venous hemodiafiltration, intravenous glucose, riboflavin, levocarnitine, and nutritional therapy aimed at reversing catabolism. Clinical and biochemical abnormalities resolved rapidly. During nine months of follow-up, the patient remained under endocrinology and metabolic disease care with dietary management, experienced no recurrent metabolic crisis, and required no further renal replacement therapy. This case highlights hypoketotic hypoglycemia in association with severe metabolic acidosis as an important diagnostic clue to metabolic decompensation and illustrates how MADD may closely resemble a surgical acute abdomen.

Background/Objectives: Adult modified Renal Angina Index (mRAI) formulations predict acute kidney injury, but their association with major adverse kidney events at 90 days (MAKE90) remains unclear. We examined the association in critically ill adults without established chronic kidney disease (CKD). Methods: This retrospective cohort included 250 adults admitted to a tertiary intensive care unit (ICU) between December 2023 and April 2025. mRAI was calculated from data available at ICU admission. MAKE90 was defined as death, renal replacement therapy, or persistent renal dysfunction within 90 days. We used logistic regression, receiver operating characteristic analysis, and nested-model comparisons. Results: Admission mRAI was higher in patients with MAKE90 than in those without MAKE90 (median 10 [IQR 5–20] vs. 3 [IQR 1–6]; p < 0.001). After adjustment for SOFA score and sepsis, mRAI remained associated with MAKE90 (adjusted OR per point from the linear model, 1.073; 95% CI, 1.032–1.116). Spline analysis demonstrated a significant nonlinear association (p = 0.004), indicating that the per-point OR should be interpreted as a summary estimate rather than a constant effect across the score range. The AUC of mRAI was 0.752 (95% CI, 0.691–0.814), higher than that of admission AKI stage (0.653) and not significantly different from APACHE II (0.702) or SOFA (0.718). Adding mRAI to SOFA and sepsis raised the AUC from 0.735 to 0.782. Conclusions: In critically ill adults without established CKD, higher admission mRAI remained associated with MAKE90 after adjustment for SOFA score and sepsis and showed moderate discrimination. External validation in larger, independent cohorts is needed to confirm these findings.