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    Alterations in neuroendocrine axes in brain-dead patients
    (Springer Int Publ Ag, 2023) Akbas, Turkay; Ozturk, Ayhan
    PurposeTo identify changes in anterior pituitary gland hormone levels in brain-dead patients and alterations in free triiodothyronine (fT3), free thyroxine, cortisol, testosterone, and estradiol levels.MethodsTen postmenopausal women and 22 men with brain death (BD) were included. The first blood sample for determination of hormones (pre-BD) was collected when the clinician observed the first signs of BD. The second blood sample (BD day) was drawn after BD certification.ResultsFemale patients exhibited lower follicle-stimulating hormone and prolactin levels pre-BD and luteinizing hormone, follicle-stimulating hormone, and prolactin levels on BD day than the age-matched controls. Male patients' sex hormone levels were similar to those of the age-matched controls, except for testosterone levels, which were low in both consecutive measurements. All gonadotropins and prolactin levels were above the tests' lower detection limits (LDLs), except for one male patient with gonadotropin levels below the LDLs of the tests. Estradiol levels in both sexes ranged from normal to elevated. FT3 levels were significantly decreased in the two measurements. Thyroid-stimulating hormone (TSH) levels were low in eight patients and all low TSH levels were above the test's LDL. The remaining patients had normal or elevated TSH levels. The median adrenocorticotropic hormone (ACTH) and cortisol levels were within normal limits. All cortisol and ACTH levels were above the tests' LDLs, except for one patient with ACTH levels below the LDL in both measurements.ConclusionThis study supports the hypothesis that the anterior pituitary gland continues to function in the brain-dead state.
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    A Case of Pulmonary and Central Nervous System Invasive Aspergillosis with Characteristic Radiological Findings
    (Soc Turkish Intensivists - Sti, 2024) Akbas, Turkay; Karahan, Fatih; Ogul, Hayri; Onec, Birgul; Onmez, Attila; Unlu, Nisa; Balbay, Ege Gulec
    Central nervous system invasive aspergillosis is a rare fatal infection responsible for the majority of brain lesions in immunocompromised patients. A 56-year-old man with diabetes mellitus and non-Hodgkin's lymphoma was admitted to the emergency department with a diagnosis of pneumonia-related sepsis. At presentation, cranial computed tomography (CT) and magnetic resonance imaging were normal, but thoracic CT revealed right lung pneumonia, and antibiotic therapy was initiated. Control CT scans performed on the 13th day of admission because the patient had subsequently become hypotensive and somnolent revealed halo signs in the lungs and multiple hypodense lesions within the cerebrum, consistent with invasive aspergillosis. A post-contrast cranial CT scan also revealed vascular enhancement within the hypodense lesions, known as the central vascular sign. In conclusion, central nervous system aspergillosis can be diagnosed by means of tubular enhanced focuses in hypodense lesions on contrast-enhanced CT scans.
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    A Case of Pulmonary and Central Nervous System Invasive Aspergillosis With Characteristic Radiological Findings
    (Soc Turkish Intensivists - Sti, 2024) Akbas, Turkay; Karahan, Fatih; Ogul, Hayri; Onec, Birgul; Onmez, Attila; Unlu, Nisa; Balbay, Ege Gulec
    Central nervous system invasive aspergillosis is a rare and fatal infection that accounts for the majority of brain lesions in immunocompromised patients. A 56-year-old man with diabetes mellitus and non-Hodgkin's lymphoma was admitted to the emergency department with a diagnosis of pneumonia-related sepsis. At presentation, cranial computed tomography (CT) and magnetic resonance imaging were normal. However, thoracic CT revealed right lung pneumonia, and antibiotic therapy was initiated. Control CT scans performed on the 13(th) day of admission-because the patient had subsequently become hypotensive and somnolent- revealed halo signs in the lungs and multiple hypodense lesions within the cerebrum, consistent with invasive aspergillosis. A post-contrast cranial CT scan also revealed vascular enhancement within these hypodense lesions, known as the central vascular sign. In conclusion, central nervous system aspergillosis can be diagnosed by means of tubular enhanced foci in hypodense lesions on contrast-enhanced CT scans.
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    Characteristics and outcomes of patients with chronic obstructive pulmonary disease admitted to the intensive care unit due to acute hypercapnic respiratory failure
    (Korean Soc Critical Care Medicine, 2023) Akbas, Turkay; Gunes, Harun
    Background: The study aimed to describe the clinical course, outcomes, and prognostic factors of chronic obstructive pulmonary disease (COPD) patients with acute hypercapnic respiratory failure. Methods: This retrospective study involved patients with acute hypercapnic respiratory failure due to COPD of any cause admitted to the intensive care unit (ICU) for non-invasive or invasive mechanical ventilation (IMV) support between December 2015 and February 2020. Results: One hundred patients were evaluated. The main causes of acute hypercapnic respiratory failure were bronchitis, pneumonia, and heart failure. The patients' mean Acute Physiology and Chronic Health Evaluation (APACHE) II score was 23.0 +/- 7.2, and their IMV rate was 43%. ICU, in-hospital, and 90-day mortality rates were 21%, 29%, and 39%, respectively. Non-survivors had more pneumonia, shock within the first 24 hours of admission, IMV, vasopressor use, and renal replacement therapy, along with higher APACHE II scores, lower admission albumin levels and PaO2/FiO(2) ratios, and longer ICU and hospital stays than survivors. Logistic regression analysis identified APACHE II score (odds ratio [OR], 1.157; 95% confidence interval [CI], 1.017-1.317; P=0.026), admission PaO2/FiO(2) ratio (OR, 0.989; 95% CI, 0.978-0.999; P=0.046), and vasopressor use (OR, 8.827; 95% CI, 1.650-47.215; P=0.011) as predictors of ICU mortality. APACHE II score (OR, 1.099; 95% CI, 1.021-1.182; P=0.011) and admission albumin level (OR, 0.169; 95% CI, 0.056-0.514; P=0.002) emerged as predictors of 90-day mortality. Conclusions: APACHE II scores, the PaO2/FiO(2) ratio, vasopressor use, and albumin levels are significant short-term mortality predictors in severely ill COPD patients with acute hypercapnic respiratory failure.
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    Evaluation of whole blood thiamine pyrophosphate concentrations in critically ill patients receiving chronic diuretic therapy prior to admission to Turkish intensive care units: A pragmatic, multicenter, prospective study
    (W B Saunders Co-Elsevier Inc, 2023) Gundogan, Kursat; Sahin, Gulsah G.; Ergul, Serap S.; Ozer, Nurhayat T.; Temel, Sahin; Akbas, Turkay; Ercan, Talha
    Background/Objectives: Thiamine plays a pivotal role in energy metabolism. The aim of the study was to deter-mine serial whole blood TPP concentrations in critically ill patients receiving chronic diuretic treatment before ICU admission and to correlate TPP levels with clinically determined serum phosphorus concentrations.Subjects/Methods: This observational study was performed in 15 medical ICUs. Serial whole blood TPP concen-trations were measured by HPLC at baseline and at days 2, 5 and 10 after ICU admission. Results: A total of 221 participants were included. Of these, 18% demonstrated low TPP concentrations upon admission to the ICU, while 26% of participants demonstrated low levels at some point during the 10-day study period. Hypophosphatemia was detected in 30% of participants at some point during the 10-day period of observation. TPP levels were significantly and positively correlated with serum phosphorus levels at each time point (P < 0.05 for all).Conclusions: Our results show that 18% of these critically ill patients exhibited low whole blood TPP concen-trations on ICU admission and 26% had low levels during the initial 10 ICU days, respectively. The modest correlation between TPP and phosphorus concentrations suggests a possible association due to a refeeding effect in ICU patients requiring chronic diuretic therapy.
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    Intensive Care Practice during COVID-19 Pandemia in Duzce University
    (Duzce Univ, 2020) Akbas, Turkay; Esbah, Ali Umit
    Nearly 5% of patients with COVID-19 need intensive care unit (ICU) admission due to the severity of disease progress. These patients generally have pneumonia induced acute respiratory disease syndrome (ARDS) and mostly need invasive mechanic ventilation. ARDS is a specific disease state that needs a long and complex treatment period. Since critical patients with COVID-19 have high viral loads and require a long therapy period, the risk of disease transmission from patients to medical staffs is high. Therefore, healthcare personnel should wear personal protective equipment (gloves, respirators, full bodysuits, bonnet, safety glasses, and full shield in the case of contact with airway) during the invasive procedures and therapies. In this article, we wanted to share our own experience of caring for critically ill patients with COVID-19-pandemia.
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    The Relationship between the Sydney Classification and the First-Line Treatment Efficacy in Helicobacter-Associated Gastritis
    (Karger, 2020) Tasci, Elif Senocak; Akbas, Turkay
    Objective: Helicobacter pyloriis responsible for a wide spectrum of diseases. Due to ease of use and access, the standard triple therapy is being used as first-line eradication in many areas. Intestinal metaplasia (IM) is a precancerous lesion that requires eradication therapy. Our aim is to investigate the effect of IM on the standard triple therapy success in H. pylori-positive patients. Subjects and Methods: The patients who were referred to Duzce University Hospital and Avrasya Hospital Gastroenterohepatology clinic between January 2014 and December 2016 and diagnosed with H. pylori-positive gastritis and underwent first-line eradication were evaluated retrospectively. Biopsy specimens were evaluated according to the updated Sydney system. All patients diagnosed with H. pylori started treatment with pantoprazole 40 mg b.i.d., amoxicillin 1 g b.i.d. and clarithromycin 500 mg b.i.d. for 14 days. Results: The mean age of 181 patients included in the study was 55.5 +/- 7.8. The success rate of H. pylori eradication was found to be low in severe chronic inflammation (p = 0.001). The success rate was found to be high among patients with no neutrophil activity (p = 0.009). As the intensity of IM increased, density of H. pylori was found to be decreased (p = 0.019). There was no correlation between glandular atrophy, IM, and H. pylori eradication success rate (p = 0.390 and p = 0.812). Conclusion: The severity of chronic inflammation is the most effective Sydney criteria for success of eradication, while the presence on IM does not have any effect.
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    Treatment of critically ill patients with acute hypercarbic respiratory failure by average volume-assured pressure support mode
    (Wiley, 2021) Akbas, Turkay; Altun, Gulsah
    Objectives Average volume-assured pressure support (AVAPS), a dual mode, delivers a set tidal volume (TV) per kg by adjusting the pressure between upper and lower inspiratory positive airway pressures (IPAP). Thus, ventilation is presumed to be happened effectively by sending a guaranteed TV. This study was aimed to evaluate the effectiveness of AVAPS mode in critically ill patients with acute hypercarbic respiratory failure (HRF) and compare the results with bilevel positive airway pressure-spontaneous/timed (BPAP-S/T) mode. Methods Sixty patients were assigned to BPAP-S/T (n = 29) and AVAPS modes (n = 31). Maximum IPAP was started at 20 cmH(2)O and minimum IPAP was set at 5 cmH(2)O higher than expiratory positive airway pressure (EPAP) in AVAPS mode. IPAP was started at 15 cmH(2)O in BPAP-S/T mode. IPAP levels were titrated up to 30 cmH(2)O during noninvasive mechanic ventilation (NIMV) with a targeted TV of 6-8 mL/kg. Patients were followed for 5 days. Results No differences were found in pH, paCO(2), HCO3, TV and EPAP between the two groups when compared separately by days. Maximum IPAP levels were significantly high in AVAPS mode in all times (P < 0.001). The length of stay (LOS) in intensive care unit (ICU) (P = 0.994) and hospital (P = 0.509), hours of NIMV use per day (P = 0.101) and NIMV success rate (P = 0.931) were identical between the two groups. ICU (P = 0.931), hospital (P = 0.800), 6-month (P = 0.919) and 1-year (P = 0.645) mortality rates were also not different between the both groups. Conclusions AVAPS mode had similar efficiency with BPAP-S/T mode regarding the NIMV treatment success in critically ill patients with acute HRF.