Purpose: The aim of this retrospective observational study is to compare C-reactive protein to albumin ratio and CURB-65 score in the emergency department in terms of predicting mortality in patients over the age of 18 who were hospitalized for COVID-19 pneumonia. Materials and Methods: The study includes 613 patients hospitalized between March 15 and April 30, 2020 due to COVID-19 pneumonia detected on thorax computed tomography at the emergency department pandemic area. Hospitalized patients were divided into groups according to positive and negative real-time polymerase chain reaction results. Results: While 73.1% (n: 448) of 613 patients included in the study were hospitalized in the ward, 26.9% (n: 165) were hospitalized in intensive care. 8.6% (n: 53) of the total patients died. In non-survivors patients the mean CURB 65 score was 4±1 (and C-Reactive Protein to Albumin Ratio was 5.6±4.2 Multivariate logistic regression analysis showed that CURB 65 and high C-Reactive Protein to Albumin Ratio are independent risk factors for COVID-19 pneumonia. Conclusion: The C-reactive protein to albumin ratio is as sensitive as CURB 65 and can guide the clinician in the early detection of patients with poor prognosis COVID-19 pneumonia. Amaç: Bu retrospektif gözlemsel çalışmanın amacı, COVID-19 pnömonisi nedeniyle hastaneye yatırılan 18 yaş üstü hastalarda mortaliteyi öngörme açısından acil serviste bakılan C-reaktif protein/albumin oranı ile CURB-65 skorunun karşılaştırılmasıdır. Gereç ve Yöntem: Çalışma 15 Mart-30 Nisan 2020 tarihleri arasında acil servis pandemi alanında toraks bilgisayarlı tomografisinde COVID-19 pnömonisi tespit edilerek hastaneye yatırılan 613 hastayı kapsamaktadır. Hastanede yatan hastalar pozitif ve negatif gerçek zamanlı polimeraz zincir reaksiyonu sonuçlarına göre gruplara ayrıldı. Bulgular: Çalışmaya dahil edilen 613 hastanın %73,1'i (n:448) serviste yatarken, %26,9'u (n:165) yoğun bakımda yatmaktaydı. Toplam hastaların %8,6'sı (n:53) öldü. Ölen hastalarda CURB 65 skoru ortalama 4±1 ve C-reaktif protein/albümin oranı 5.6±4.2 idi.. Çok değişkenli lojistik regresyon analizi, CURB 65 skorunu) ve yüksek C-reaktif protein/albümin oranı olduğunu gösterdi.) COVID-19 pnömonisi için bağımsız risk faktörleri olarak göstermiştir. Sonuç: C-reaktif protein/albumin oranı, kötü prognozlu COVID-19 pnömonisi olan hastaların erken tespitinde CURB 65 kadar duyarlı olup klinisyene yol gösterebilir.

OBJECTIVE: Hypertriglyceridemia (HTG) is the third-most common cause of acute pancreatitis. Plasmapheresis is an extracorporeal treatment method used for treatment. This study aimed to investigate the efficacy of medical treatment and plasmapheresis in patients with acute pancreatitis due to HTG. METHODS: This was a retrospective cross-sectional study. The patients were divided into two groups according to the treatment they received as those who received only medical treatment and those who performed plasmapheresis with medical treatment. According to the treatment received by the patients; clinical, demographic, and laboratory data, Ranson scores, and bedside index of severity in acute pancreatitis (BISAP) scores, decrease in triglyceride levels in 24 h, length of hospital stay, and outcomes were recorded. RESULTS: Forty-seven patients were included in the study. The level of triglyceride decreases at the 24^th h was 59.7% ±17.3% in those who received medical treatment and was 70.4% ±15.1% in those who received plasmapheresis (P = 0.032). Receiver operating characteristic curve analysis was performed to predict the need for plasmapheresis treatment, area under the curve (AUC) value of the triglyceride level was the highest (AUC: 0.822, 95% confidence interval: [0.703–0.940]; P < 0.001), the sensitivity and specificity were 83.3% and 72.4%, respectively, and the cut-off value of triglyceride was accepted as 3079.5 mg/dL. CONCLUSION: Plasma triglyceride levels and BISAP score on admission may help physicians to predict the need for plasmapheresis. Plasmapheresis helps to rapidly reduce triglyceride levels in patients with HTG-associated acute pancreatitis.

Introduction: This study aims to evaluate presenting symptoms, clinical and laboratory findings, and treatment modalities of adult patients presenting with mushroom poisoning treated in the intensive care unit (ICU) with special consideration of extracorporeal liver support systems. Materials and methods: Records of patients with mushroom poisoning treated in the ICU between January 2007 and December 2014 were analyzed retrospectively. Results: Sixteen adult patients were treated in the ICU for mushroom poisoning during the designated study period. Presentation to the hospital was most common during October of each year. Average time from ingestion of mushrooms to first symptoms was 17.81 hours, and to ICU admission was 2.38 days. The most common symptoms were nausea, vomiting and diarrhea. The most common laboratory finding was elevation of liver transaminases. In cases with elevated liver transaminases, penicillin G, silibinin and N-acetyl cysteine were used. Extracorporeal support systems were used in 9 cases. Two cases underwent emergency liver transplantation. Conclusion: Liver transplantation is the most definitive and effective treatment in indicated cases of mushroom poisoning. Extracorporeal support systems should be considered in the early period both as a treatmet modality on their own or to save time until the definitive treatment is possible. The question of which extracorporeal detoxification technique to use is difficult to answer and controlled clinical trials which compare their efficacy are needed.

Introduction: Candida auris is a yeast that has a high mortality rate in critically ill patients and is resistant to many antifungal agents enhancing its clinical importance. Our study identifies the risk factors for C. auris invasive infection, antifungal susceptibility, and outcomes. Methodology: A total of 100 adults with C. auris isolated in any clinical specimen between 07.01.2022 and 31.12.2023 were enrolled in this retrospective cohort study. Data were obtained via retrospective screening of patient files. C. auris identification was performed by MALDI-TOF MS. Antifungal susceptibility was carried out by VITEK 2 and CDC methodology. Colonized and infected patients were compared to assess the risk factors for and outcomes of invasive infection. Results: Twenty (20%) patients developed invasive infections, with 16 (80%) having candidemia. Age, Candida score, prior antifungal agent use, number of previously used antibiotics ≥ 3, presence of central venous catheter or nasogastric catheter, and being monitored out of burn unit were the risk factors, and Candida score was identified as an independent risk factor for invasive infection development. Of the isolates, 55% were resistant to fluconazole and 100% were resistant to amphotericin B. No micafungin resistance was detected. The overall mortality rate in patients with invasive infection was 75%. Conclusions: Knowing the risk factors for invasive infection will help early initiation of empirical antifungal therapy by ensuring early identification of high-risk patients, and Candida score appears to be an effective method for this. Revealing antifungal susceptibility will also guide the selection of appropriate empirical treatment.

Akut karaciğer yetmezliği hızlı seyirli, ölümcül bir hastalıktır. Tabloya sarılık, koagülopati ve hepatik ensefalopati hakimdir. Sistemik inflamasyon; serebral ödem ve organ fonksiyon bozukluklarının hem gelişimini hem de ciddiyetini yönlendirir. Son on yılda yoğun bakım yönetimindeki gelişmeler ile refrakter intrakranyal hipertansiyona bağlı kayıplar azalmış olsa da zamanında yapılan karaciğer transplantasyonu, seçilmiş hastalarda kesin tedavi olmaya devam etmektedir. Bu yazıda gecikmiş başvurulu parasetamol kullanımına bağlı akut karaciğer yetmezliği olgusunda uygulanan ileri tedaviler geniş olarak ele alınmış ve bilimsel kanıtlar eşliğinde sunulmuştur. Karaciğer yetmezliğinde sağkalımı artırmayı hedefleyen ileri tedaviler, toksinlerin ve inflamatuar mediatörlerin uzaklaştırılmasına dayanırken, aynı zamanda karaciğer transplantasyonu ya da spontan hepatik rejenerasyon beklenirken karaciğerin sentetik ve metabolik fonksiyonunu desteklemeyi amaçlar. Erken renal replasman tedavisi ve potansiyel olarak terapötik plazma değişimi, yakın zamanda akut karaciğer yetmezliği yönetiminde merkezi tedaviler olarak kabul edilmektedir. Acute liver failure is a rapidly progressive and life-threatening clinical syndrome characterized by jaundice, coagulopathy, and hepatic encephalopathy. Systemic inflammation plays a pivotal role in both the development and severity of cerebral edema and multiple organ dysfunction. Although advances in critical care management over the past decade have reduced mortality associated with refractory intracranial hypertension, timely liver transplantation remains the definitive treatment in carefully selected patients. In this report, advanced therapeutic strategies implemented in a case of paracetamol-induced acute liver failure with delayed presentation are comprehensively reviewed and discussed in light of current scientific evidence. Advanced supportive therapies aimed at improving survival in acute liver failure are primarily based on the removal of circulating toxins and inflammatory mediators, while simultaneously providing support for the liver’s synthetic and metabolic functions as a bridge to liver transplantation or spontaneous hepatic regeneration. Early initiation of renal replacement therapy and, potentially, therapeutic plasma exchange have recently emerged as cornerstone interventions in the contemporary management of acute liver failure.