Background: Sepsis-induced acute kidney injury (AKI) involves oxidative stress and inflammation. Omega-3 (OMG-3) fatty acids possess antioxidant properties, but their impact on the mitochondrial AMPK/SIRT1/PGC-1α/NRF2/FOXO3 axis in AKI remains unclear. Methods: Thirty-two male Wistar rats were divided into Control, LPS (5 mg/kg), LPS + OMG-3 (500 mg/kg/day), and OMG-3 groups. Renal tissues were analyzed for histopathology, immunohistochemistry (TNF-α, Caspase-3, HSP70), and gene expression (AMPK, SIRT1, PPGC-1α NRF2, FOXO3). Results: LPS caused severe tubular injury, increased TNF-α, Caspase-3, and HSP70 expression, while significantly downregulating the AMPK/SIRT1/PGPGC-1αRF2/FOXO3 signaling pathway. OMG-3 treatment alleviated histopathological damage, suppressed inflammatory and apoptotic markers, and restored the expression of mitochondrial and antioxidant genes. Conclusions: OMG-3 fatty acids protect against LPS-induced AKI by upregulating the gene expression of components in the AMPK/SIRT1/PGCPGC-1αF2/FOXO3 axis and suppressing NF-κB-driven inflammation. This dual regulation highlights OMG-3 as a potential therapeutic agent for sepsis-related renal injury.

Background and Objectives: Traumatic brain injury (TBI) triggers oxidative stress, mitochondrial dysfunction, and sterile inflammation. Amantadine (ATD), a weak NMDA receptor antagonist, has shown neuroprotective potential, but its mechanistic basis remains unclear. This study examined whether ATD treatment is associated with changes in molecular and histological markers related to the HIF-1α/BNIP3L/HMGB1-mediated hypoxia–mitophagy–inflammation response in a rat TBI model. Materials and Methods: Thirty-two Wistar rats were assigned to four groups: sham, trauma, trauma + ATD (1 day), and trauma + ATD (7 days). TBI was induced using the impact-acceleration model, and ATD (45 mg/kg, i.p.) was administered post-injury. Oxidative stress indices (TOS, TAS, OSI), histopathology, inflammatory/apoptotic markers (CRP, TNF-α, Caspase-3), and gene expression (HIF-1α, BNIP3L, HMGB1) were evaluated. Results: ATD improved oxidative balance and histopathological integrity while reducing TNF-α, CRP, and Caspase-3 immunoreactivity. qPCR analysis showed lower HIF-1α, BNIP3L, and HMGB1 expression in ATD-treated groups, which is consistent with attenuation of hypoxia-related, mitochondrial stress-associated, and damage-associated molecular pattern-associated signaling after injury. Conclusions: In this experimental model, amantadine ameliorated oxidative, inflammatory, and apoptotic markers and was associated with reduced expression of HIF-1α, BNIP3L, and HMGB1. These findings support a mechanistic correlation between ATD treatment and suppression of secondary injury signatures; however, causal pathway relationships and functional neurological outcomes were not assessed.

Early physiologic warning scores (EPWS) are used to detect clinical deterioration by monitoring vital signs and early warning signs. However, their role in the obstetric population, particularly during the preoperative period before cesarean delivery, remains underexplored. To evaluate the effectiveness of three maternal early physiologic warning systems—Modified Early Obstetric Warning Score (MEOWS), Maternal Early Warning Criteria (MEWC), and Maternal Early Warning Triggers (MEWT)—in predicting short-term maternal and neonatal outcomes in the parturient patients undergoing cesarean section. In this prospective observational study, 304 parturient patients scheduled for cesarean delivery at a tertiary care hospital were evaluated. Preoperative physiological data were used to calculate MEOWS, MEWC, and MEWT scores. Patients were classified into “high risk” (Group 1) or “no risk” (Group 2) categories based on predefined thresholds. Primary outcomes included intensive care unit (ICU) admission and neonatal APGAR scores. Secondary outcomes involved Aldrete scores, intraoperative hemodynamic parameters, and type of anesthesia. Patients identified as “high risk” by MEOWS had significantly lower neonatal APGAR and maternal Aldrete scores, along with higher systolic and diastolic blood pressures and heart rates (p < 0.05). MEOWS also more effectively predicted ICU admission compared to MEWC and MEWT (p < 0.05). No maternal deaths were recorded. Emergency procedures were more frequent in patients identified as “high risk” by MEWC and MEWT. MEOWS, MEWC, and MEWT scores can help identify preoperative high-risk patients who may require cesarean sections. MEOWS demonstrated superior sensitivity in predicting postoperative complications and ICU admission. Incorporating EPWS in the preoperative evaluation may improve maternal and neonatal outcomes.

Gynecological malignancies are significant causes of mortality and morbidity in women worldwide. Although surgery is an important treatment method, both the extent of the surgery and the factors related to the patient affect postoperative processes. The National Early Warning Score 2 (NEWS2) is a simple, inexpensive, and safe early warning score developed in 2012 and updated in 2017. Although it is not commonly used in surgical patients, its use in patients who will undergo major surgery may provide insights about the postoperative process. This study investigates the importance of NEWS2 and its relationship in patients with for major gynecologic oncology surgery. Forty-four patients with gynecologic malignancies scheduled for major abdominal surgery were included in this study. Patients with a NEWS-2 score of <3 were included in group 1, and patients with a NEWS-2 score of more than 3 were included in groups 2. NEWS2 Score, Sequential Organ Failure Assessment (SOFA), and Acute Physiology and Chronic Health Evaluation 2 scores (APACHE 2) were calculated. In addition, postoperative routine clinical and laboratory parameters were evaluated. Operation time, duration of intubation in the intensive care unit (ICU), the length of the intensive care stay, and length of hospitalization were recorded. Duration of intubation in the ICU in group 1 with a NEWS2 <3 [8.2 (0-18) vs 16.2 (3-39), respectively; p<0.01], ICU length of stay [21.6 (4-27) vs 47.3 (4-113), respectively; p<0.01], length of hospitalization [11.6 (5-56) vs 18.6 (8-67), respectively; p3 was significantly higher compared to group 2. The SOFA score was significantly higher in group 2 compared with group 1 [1.2±0.5 vs 4.1±1.9; respectively; p<0.01]. In the correlation analysis, the NEWS2 score level was positively correlated with the SOFA score (p<0.001, r=0.81) and hospitalization time (p<0.001, r=0.60) and neutrophil lymphocyte ratio (NLR) (p<0.001, r=0.47). These findings suggest that the NEWS2 score may be correlated with the length of intensive care intubation, length of intensive care stay, and length of hospitalization. NEWS2 is an effective and simple scoring system that provides information about postoperative outcomes in gynecologic oncology patients scheduled for major surgery.

SUMMARY OBJECTIVE: The aim of this study was to evaluate optic nerve sheath diameter using ultrasonography in patients with clinical and radiological suspicion of elevated intracranial pressure in the intensive care unit. Elevated intracranial pressure is a critical condition resulting from various intracranial pathologies and constitutes a major cause of morbidity and mortality. METHODS: Several invasive and noninvasive methods are available for detecting elevated intracranial pressure. Although invasive methods are regarded as the gold standard, they are associated with certain disadvantages. Ultrasonographic measurement of optic nerve sheath diameter, a noninvasive technique, has gained prominence owing to its repeatability, bedside applicability, and cost-effectiveness. From June to December 2023, 50 patients with suspected elevated intracranial pressure based on cranial computed tomography findings and clinical presentation, along with 36 healthy volunteers, were included in the study. RESULTS: Optic nerve sheath diameter was significantly greater in patients (right 6.13±0.50 mm, left 6.13±0.51 mm) compared with controls (right 4.23±0.22 mm, left 4.23±0.21 mm; p<0.001). Moreover, optic nerve sheath diameter was significantly correlated with mortality, as well as with Glasgow Coma Scale, Full Outline of UnResponsiveness, Acute Physiology and Chronic Health Evaluation II, and Sequential Organ Failure Assessment scores. Patients with computed tomography findings such as brain edema and midline shift also exhibited significantly elevated optic nerve sheath diameter values. CONCLUSION: Ultrasonographic measurement of optic nerve sheath diameter represents a reliable adjunctive modality for identifying patients with radiological signs of elevated intracranial pressure and for prognostic assessment in the intensive care unit. Nevertheless, the lack of invasive intracranial pressure monitoring as the gold standard constitutes a major limitation, and validation against direct intracranial pressure measurements is warranted in future studies. This technique may be particularly useful in hemodynamically unstable patients who cannot be safely transferred for computed tomography imaging.

Introduction: Intensive care physicians are increasingly involved in decision making about the prognosis of intensive care unit ICU patients. With this study; we aimed to evaluate the power of clinician foresight at prediction of mortality in patient at triage to intensive care and patient follow-up. Materials and Methods: This study was conducted in ICUs located in various geographical regions of Turkey between January 1, 2017-April 30, 2017. The clinical research was planned as observational, multicenter, cross-sectional. Results: A total of 1169 intubated patients were followed in 37 different ICU. At the beginning of the follow-up we asked the physician who will follow the patient in the ICU to give a score for the probability of survival of the patients. Scoring included a total of 6 scores from 0 to 5, with the "0" the worst probability "5" being the best. According to this distribution, only 1 (0.9%) of 113 patients who were given 0 points survived. Three (6.1%) of 49 with the best score of 5 died. Survival rates were significantly different in each score group (r: -0.488; p< 0.001). After the combined mortality estimation scores based on the clinical observations of the physicians (0 and 1 point score was combined as non-survive, 4 and 5 score was combined as survived) 320 of the 545 patients were estimated to be dead and 225 were predicted survival. Sensitivity and spesifity of scoring system to predict mortality was 91.56% (95% Cl: 87.96-94.37), 76.89% (95% CI: 70.82-82.23) respectively. Conclusion: In this study, we concluded that the physicians who follow the patients in the ICU can predict the poor prognosis at the time of admission and the high mortality rate. The physician's opinion on mortality estimation should be considered in intensive care mortality scoring in addition to other laboratory and clinical parameters.