Objective: Causing a global pandemic, the coronavirus disease 2019 (COVID-19) has caused millions of people to become infected and many more to die. In this study we aimed to investigate whether routinely evaluated clinical and laboratory values ​​can predict the mortality of patients with COVID-19 disease.Materials and Methods: In our study, routine laboratory parameters of 89 patients hospitalized in the general intensive care unit with the diagnosis of COVID 19 were retrospectively analyzed. The aggregate index of systemic inflammation (AISI) and other inflamatuar values were calculated from blood tests in patients with positive COVID-19 polymerase chain reaction test and with ground-glass opacity on lung tomography. Patients were divided into two groups as those who died (non-survivors) and those who were discharged (survivors) during the intensive care follow-ups. Results: In our study, in 48 patients who died during follow-up, the indexes of AISI, other inflamatuar paramaters and the biochemical parameters such as troponin I, d-dimer, ferritin and procalcitonin were significantly higher than in discharged patients. Hypertension and higher AISI and ferritin levels were statistically associated with reduced survival in Cox regression analysis (Hazard ration (HR): 3.176; 95% Confident interval (CI): 1.122-8.991, p=0.03, HR: 1.114; 95% CI: 1.060-1.348, p=0.042, HR=1.072;95% CI: 1.014-1.242, p=0.011, respectively. Conclusion: Inflammation indexes derived from blood tests and acute phase reactants such as ferritin can guide us in planning the treatment strategy and risk stratification in patients with COVID-19 in intensive care follow-ups.

Aim: The aim was to determine whether urine pH changed or not with different pH values of drinking water. With the results obtained from animal studies, comments can be made about the effect of water with different pH levels that people drink on kidney stones. Method: A total of 24 Wistar Albino rats were divided into three groups containing eight rats each: the first group was given water with pH 5.5, the second group was given water with pH 7 and the third group was given water with pH 8.2 in the same environment and conditions during 13 days. All rats consumed water in line with their natural feeding habits. All rats had urine pH measurements performed and recorded every day at the same time. The groups were later compared in terms of daily pH values. Results: When daily urine pH values were compared, there were statistically significant differences between pH measurements on the first, fourth and seventh day (p=0.02, p=0.017 and p=0.007, respectively). When first-day values are compared with post-hoc analyses, the urine pH in Group 2 was identified to be lower compared to Group 1 and Group 3 (p<0.001). When the fourth-day values were assessed, the urine pH of Group 2 was observed to be higher than Group 1 and Group 3 (p<0.001). On the seventh day, Group 3 had higher urine pH compared to the other groups (p<0.001). Conclusion: The variation in drinking water pH does not directly change urine pH; however, it causes a change in the urine pH on different days.

COVID-19,intensive care,intensive care unit,pandemic,follow-up

Yüz kadarının toksik olduğu bilinmekle beraber, yeryüzünde 5.000’den fazla mantar çeşidi bulunmaktadır. Bunların arasında en zehirli türler Amanita ve Gallerina türlerine ait olanlardır. Türkiye’deki ölümcül mantar zehirlenmelerinin %90’ından sorumlu olan, ciddi karaciğer, böbrek ve santral sinir sistemi hasarı ile seyreden alfa-amanitin ve beta-amanitin toksinleri Amanita phalloides tarafından üretilmektedir. Sunmayı amaçladığımız iki olgu, ormanlık alanda mantar toplayıp tüketen 55 ve 42 yaşlarında iki erkek hastadır. Birincisi tüketimden 18 diğeri ise 24 saat sonra ilçe devlet hastanesine bulantı, kusma, ishal ve halsizlik şikayetleri ile başvurmuşlardır. Yapılan tetkiklerde karaciğer fonksiyon testlerinde artış gözlenen hastalar ileri tetkik ve tedavi için hastanemize sevk edildiler ve yoğun bakımımızdaki başarılı tedavilerinin sonrasında şifa ile taburcu edildiler.

Background and Objectives: Epidural analgesia after total knee arthroplasty (TKA) is effective, but its side effects are largely dose-dependent. This study evaluated whether adding intraoperative periarticular multimodal infiltration to epidural patient-controlled analgesia (PCA) reduces epidural drug consumption and side effects. Materials and Methods: In this prospective, single-centre randomised controlled trial (ClinicalTrials.gov NCT06872528, registered 24 February 2025), 72 patients undergoing unilateral TKA under combined spinal–epidural anaesthesia were randomised to epidural PCA plus periarticular infiltration with a modified Ranawat solution (Group EP) or epidural PCA alone (Group E). Eleven patients were withdrawn because of catheter dislodgement, and 61 were analysed (Group EP, n = 31; Group E, n = 30). The primary outcomes were epidural local anaesthetic consumption and the incidence of complications and rescue analgesia. Pain (visual analogue scale, VAS), PCA bolus number, haemodynamics and time to first voiding were also recorded for 48 h. Results: VAS scores did not differ between groups at any time point. Cumulative epidural volume was lower in Group EP at 24 h (188.4 ± 43.4 vs. 213.2 ± 44.5 mL; p = 0.032) but not at 48 h (344.0 ± 52.5 vs. 361.8 ± 57.8 mL; p = 0.213). Epidural volume and bolus number were lower in Group EP during the 2–6 h and 12–24 h intervals. Vomiting was less frequent in Group EP (9.7% vs. 40.0%; p = 0.006). Rescue analgesia, nausea, pruritus, urinary retention, haemodynamics and time to first voiding were similar. Conclusions: Adding periarticular infiltration to epidural PCA did not further reduce pain scores, but it reduced epidural consumption during the first postoperative day and the incidence of vomiting; the difference in epidural consumption was modest and should be confirmed in larger trials.

Objectives: We aimed to compare the total amount of inhalation anesthesia consumed and the amount of fentanyl used as an additional dose in cases where transversus abdominis plane and rectus sheath blocks were applied for postoperative analgesia. Methods: Eighty patients aged 18-75 years, classified as ASA I-II, who were scheduled for laparoscopic cholecystectomy, were included. The patients were divided into two groups: those who received a combination of transversus abdominis and rectus sheath blocks under general anesthesia (Group B, n=40), and those who received analgesia with tramadol under general anesthesia (Group C, n=40). Throughout the procedure, both groups were monitored to maintain the entropy target value between 40-60 with a maximum MAC value of 1.3. At the end of the procedure, the total amount of inhalation agent consumed, and the additional need for superficial anesthesia/analgesia, as well as the total amount of fentanyl added as an extra dose, were recorded. Results: Comparing the total amount of inhalation agent consumed throughout the case, it was found to be 27.05±7.43 mL in Group C (Control group) and 12.25±4.34 mL in Group B (Block group), with a statistically significant difference between the groups. There was a significant difference in the need for additional intraoperative and the total amount of fentanyl consumed between the groups (P<0.05). Conclusions: In laparoscopic cholecystectomy cases, we observed that the use of transversus abdominis plane block and rectus sheath block combined with standardized general anesthesia monitored by entropy reduced the amount of inhalation agent consumed, as well as the need for additional intraoperative and total opioid consumption.