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Öğe The 2-Stage Liver Transplant: 3 Clinical Scenarios(Baskent Univ, 2015) Gedik, Ender; Bicakcioglu, Murat; Otan, Emrah; Toprak, Huseyin Ilksen; Isik, Burak; Aydin, Cemalettin; Kayaalp, CuneytThe main goal of 2-stage liver transplant is to provide time to obtain a new liver source. We describe our experience of 3 patients with 3 different clinical conditions. A 57-year-old man was retransplanted successfully with this technique due to hepatic artery thrombosis. However, a 38-year-old woman with fulminant toxic hepatitis and a 5-year-old-boy with abdominal trauma had poor outcome. This technique could serve as a rescue therapy for liver transplant patients who have toxic liver syndrome or abdominal trauma. These patients required intensive support during long anhepatic states. The transplant team should decide early whether to use this technique before irreversible conditions develop.Öğe Angiotensin II and angiotensin II receptor 2 levels can predict shock and mortality in septic patients(Edizioni Minerva Medica, 2022) Ozer, Ayse B.; Bicakcioglu, Murat; Baykan, Seyma; Bulut, Nilufer; Kalkan, Serkan; Demircan, Selcuk; Korkmaz Disli, ZelihaBACKGROUND: The aim of this study was to evaluate the place of angiotensin II and its receptors in the prognosis of septic patients. METHODS: Patients with sepsis and septic shock were included in the study group. The control group consisted of patients who were followed up in the ICU and had no sepsis/septic shock. Plasma angiotensin II, angiotensin receptor-1 and 2 (AT-1, AT-2) levels were evaluated first and third days.RESULTS: Angiotensin II levels were significantly lower in the septic shock and non-survivor. AT-1 levels were lower in all septic patients on the first day compared to the control. While AT-1 levels on the third day decreased in the septic shock group, it increased in the sepsis group. AT-2 levels were significantly higher in sepsis, and lower in septic shock compared to controls on the first day. Angiotensin II (95%, 82%) and AT-2 levels (100%, 87%) were observed to have high sensitivity and specificity in demonstrating the presence of shock in septic patients. Angiotensin II and AT-1/AT-2 ratios were observed to have high sensitivity and low specificity in the development of mortality.CONCLUSIONS: In septic patients, angiotensin II, AT-2 and AT-1/AT-2 levels can predict the probability of shock development and mortality. (Cite this article as: Ozer AB, Bicakcioglu M, Baykan S, Bulut N, Kalkan S, Demircan S, et al. Angiotensin II and angio-tensin II receptor 2 levels can predict shock and mortality in septic patients. Minerva Anestesiol 2022;88:1021-9. DOI: 10.23736/S0375-9393.22.16566-1)Öğe Can antibiotics affect the clinical features of patients with candidemia? The retrospective evaluation of 5 years of data in an intensive care unit(Bmj Publishing Group, 2023) Durmus, Mefkure; Kalkan, Serkan; Karahan, Sena Guzel; Bicakcioglu, Murat; Ozdemir, Nesligul; Gun, Zeynep Ulku; Ozer, Ayse BelinBackgroundCandidemia is an opportunistic infection of intensive care units (ICUs) and causes morbidity and mortality. Multiple antibiotic exposure was found to be an independent risk factor for mortality and non-albicans candidemia (NAC) in candidemia patients. AimThe aim of this study was to determine the relationship between antibiotics and clinical features of patients with candidemia, and to determine the independent risk factors for hospital stay >50 days, 30-day mortality in hospital, candidemia types, and septic shock in candidemia patients. MethodsPatients were evaluated retrospectively for 5 years. A total of 148 candidemia cases were detected and included in the study. Characteristics of cases were defined and recorded. The relationship between qualitative data was determined by the chi(2) test. Logistic regression analysis was used to determine the independent risk factors for hospital stay >50 days, 30-day mortality in hospital, candidemia types, and septic shock in candidemia patients. ResultsThe incidence of candidemia for 5 years was 4.5%. Candida parapsilosis was the most reported species with 65% (n=97). Linezolid and central venous catheters (CVC) were found to be independent risk factors for NAC. Carbapenems and cephalosporins were found in association to lower mortality. No antibiotics or characteristics were found to be independent risk factors for mortality. Some broad spectrum antibiotics and antibiotic combinations were found in relationship with hospital stay >50 days; however, none of them were found to be independent risk factors. Metisilin resistant staphylococcus aureus (MRSA) antibiotics, meropenem+linezolid piperacillin-tazobactam+fluoroquinolones and comorbidity were found in association with septic shock, although only piperacillin-tazobactam+fluoroquinolones and comorbidity were found to be independent risk factors for septic shock. ConclusionsThis study concluded that many antibiotics were safe for candidemia patients. However, clinicians should pay attention when prescribing linezolid or piperacillin-tazobactam and flouroquinolons concomitantly or sequentially for patients with candidemia risk factors.Öğe The Changes with the New Legislations(Galenos Publ House, 2023) Bicakcioglu, Murat; Gedik, EnderOrgan transplantation is the most important option for the treatment of end-stage diseases. However, there is a large difference between the number of patients on the waiting list and the number of transplants performed. The gradual increase in this difference creates ethical problems related to organ transplantation. Ethical problems and other limitations require organ transplantation to be controlled by legal regulations. In our country, organ transplantation practice is carried out under the supervision of the state. Organ Transplant Practice Regulation has been updated by being published in the Official Gazette dated 09.12.2022 and numbered 32008. Possible end-of-life decisions in brain death are stated in accordance with the conditions of our country. In cases where brain death is diagnosed, the organ preservation protocols applied are terminated in the absence of family or legal guardian approval regarding organ donation. In case of organ donation by the family or legal guardian, the organ preservation protocols needed for donor care are continued during the period until the transplantation of the organ to the waiting patient, and a solution has been presented to the intensive care physicians for the prognosis of the cases that donated or could not be donated.In the regulation in which the prerequisites of the brain death diagnostic criteria are specified, it is stated that the central body temperature should be =36 degrees C. With the new regulation, end-of-life decisions on brain death and changes made in relation to central body temperature have brought convenience in the diagnosis and follow- up process.Öğe Does COVID-19-related viral sepsis stimulate angiotensin II levels more than bacterial sepsis?(Bayrakol Medical Publisher, 2023) Demircan, Selcuk; Bulut, Niluefer; Kalkan, Serkan; Duzenci, Deccane; Bicakcioglu, Murat; Ozden, Mehmet; Dogan, ZaferAim: Angiotensin II and its receptors play a role in both COVID and bacterial sepsis. The aim of this study was to compare the levels of serum angiotensin II and its receptors in viral sepsis due to COVID-19 with the levels in bacterial sepsis.Material and Methods: The study included 62 sepsis patients (n=31 COVID and n=31 non-COVID) with similar disease severity in the tertiary ICU. The serum angiotensin II, angiotensin II receptors 1 and 2 (ATR1, ATR2) and other inflammatory parameters were measured. Demographic data and 28-day mortality were recorded.Results: Angiotensin II level was significantly higher in COVID patients than in non-COVID patients (p<0.05). ATR1 and ATR2 did not differ between the two groups. There was a negative correlation between angiotensin II and procalcitonin levels in all patients, and a positive correlation between ATR1 and procalcitonin, APACHE II score, and SOFA score in COVID patients (p<0.05).Discussion: Observation showed that angiotensin II levels were higher in patients with COVID-19 compared to those with bacterial sepsis, and ATR1 level was higher in COVID-19 patients who died. It was thought that the renin-angiotensin cascade could be stimulated differently in bacterial sepsis compared to viral sepsis due to COVID.Öğe Hydrocortisone may act through the angiotensin II receptor-2 level in patients with catecholamine-resistant septic shock(Edizioni Minerva Medica, 2023) Baykan, Seyma; Bicakcioglu, Murat; Bulut, Nilufer; Yucel, Neslihan; Ersoy, Yasemin; Uysal, Nermin Kibrislioglu; Ozer, Ayse B.BACKGROUND: This study aimed to compare the serum angiotensin II and its receptor levels (AT1, AT2) in septic patients with catecholamine-responsive or resistant. The effect of hydrocortisone treatment on angiotensin II levels in the catecholamine-resistant septic patients was evaluated.METHODS: This prospective observational study enrolled 40 patients diagnosed with septic shock based on sepsis-3 cri-teria. Patients were divided into two groups according to the noradrenalin infusion rate required to keep the mean arterial pressure above 65 mmHg: control group and hydrocortisone group (control group: below 0.5 mu g/kg/min, hydrocortisone group: above 0.5 mu g/kg/min). Serum angiotensin II, AT1, AT2 levels were measured at the time of diagnosis (A), one hour after hydrocortisone treatment (B), and three days later (C).RESULTS: In the catecholamine-resistant group, angiotensin II and AT1 levels were higher than the catecholamine-responder group in all periods. The sensitivity and specificity of AT-1 was observed to be high in all periods. AT2 levels decreased after hydrocortisone treatment in the catecholamine-resistant group and cut-off value was found 11%.CONCLUSIONS: It was concluded that angiotensin II and AT1 can be used as a biomarker of refractory septic shock and hydrocortisone may provide their blood pressure correcting effect by reducing AT2 level in these patients. AT2 can be a therapeutic target in the catecholamine-resistant septic shock patients.Öğe Potential Risk Factors for In-Hospital Mortality in Patients with Moderate-to-Severe Blunt Multiple Trauma Who Survive Initial Resuscitation(Hindawi Ltd, 2018) Yucel, Neslihan; Demir, Tuba Ozturk; Derya, Serdar; Oguzturk, Hakan; Bicakcioglu, Murat; Yetkin, FundaIntroduction. The aim was to identify risk factors that influence in-hospital mortality for patients with moderate-to-severe blunt multiple trauma (BMT) who survive initial resuscitation. Methods. The prospective study involved 195 adult patients with BMT who were admitted to a referral hospital's emergency department (ED) betweenMay 1, 2015, and May 31, 2016. Results. Forty-three (22%) of the 195 patients died in hospital. Multivariate analysis identified low blood pH (odds ratio [OR] 6.580, 95% confidence interval [CI] 1.12-38.51), high serumlactate level (OR 1.041, 95% CI 1.01-1.07), high ISS (OR 1.109, 95% CI 1.06-1.16), high APACHE II score (OR 1.189, 95% CI 1.07-1.33), traumatic brain injury (TBI) (OR 4.358, 95% CI 0.76-24.86), severe hemorrhage (OR 5.314, 95% CI 1.07-26.49), and coagulopathy (OR 5.916, 95% CI 1.17-29.90) as useful predictors of acute in-hospital mortality. High ISS (OR 1.047, 95% CI 1.02-1.08), TBI (OR 8.922, 95% CI 2.57-31.00), sepsis (OR 4.956, 95% CI 1.99-12.36), acute respiratory distress syndrome (ARDS) (OR 8.036, 95% CI 1.85-34.84), respiratory failure (OR 9.630, 95% CI 2.64-35.14), renal failure (OR 74.803, 95% CI 11.34-493.43), and multiple organ failure [MOF] (OR 10.415, 95% CI 4.48-24.24) were risk factors for late in-hospital mortality. High Glasgow Coma Scale (GCS) was a good predictor for survival at 2, 7, and 28 or more days of hospitalization (OR 0.708 and 95% CI 0.56-0.09; OR 0.835 and 95% CI 0.73-0.95; OR 0.798 and 95% CI 0.71-0.90, resp.). Conclusion. Several factors signal poor short-term outcome for patients who present to the ED with moderate-to-severe BMT: low blood pH, high serum lactate level, presence of TBI, severe hemorrhage, coagulopathy, organ failure (respiratory, renal, and MOF), and ARDS. For this patient group, ISS and APACHE II scores might be helpful for stratifying by mortality risk, and GCS might be a good predictor for survival.Öğe Potential risk factors for ın-hospital mortality in patients with moderate-to-severe blunt multipletrauma who survive ınitial resuscitation(Hındawı ltd, adam house, 3rd flr, 1 fıtzroy sq, london, w1t 5hf, england, 2018) Yucel, Neslihan; Demir, Tuba Ozturk; Derya, Serdar; Oguzturk, Hakan; Bicakcioglu, Murat; Yetkin, FundaIntroduction. The aim was to identify risk factors that influence in-hospital mortality for patients with moderate-to-severe blunt multiple trauma (BMT) who survive initial resuscitation. Methods. The prospective study involved 195 adult patients with BMT who were admitted to a referral hospital's emergency department (ED) betweenMay 1, 2015, and May 31, 2016. Results. Forty-three (22%) of the 195 patients died in hospital. Multivariate analysis identified low blood pH (odds ratio [OR] 6.580, 95% confidence interval [CI] 1.12-38.51), high serumlactate level (OR 1.041, 95% CI 1.01-1.07), high ISS (OR 1.109, 95% CI 1.06-1.16), high APACHE II score (OR 1.189, 95% CI 1.07-1.33), traumatic brain injury (TBI) (OR 4.358, 95% CI 0.76-24.86), severe hemorrhage (OR 5.314, 95% CI 1.07-26.49), and coagulopathy (OR 5.916, 95% CI 1.17-29.90) as useful predictors of acute in-hospital mortality. High ISS (OR 1.047, 95% CI 1.02-1.08), TBI (OR 8.922, 95% CI 2.57-31.00), sepsis (OR 4.956, 95% CI 1.99-12.36), acute respiratory distress syndrome (ARDS) (OR 8.036, 95% CI 1.85-34.84), respiratory failure (OR 9.630, 95% CI 2.64-35.14), renal failure (OR 74.803, 95% CI 11.34-493.43), and multiple organ failure [MOF] (OR 10.415, 95% CI 4.48-24.24) were risk factors for late in-hospital mortality. High Glasgow Coma Scale (GCS) was a good predictor for survival at 2, 7, and 28 or more days of hospitalization (OR 0.708 and 95% CI 0.56-0.09; OR 0.835 and 95% CI 0.73-0.95; OR 0.798 and 95% CI 0.71-0.90, resp.). Conclusion. Several factors signal poor short-term outcome for patients who present to the ED with moderate-to-severe BMT: low blood pH, high serum lactate level, presence of TBI, severe hemorrhage, coagulopathy, organ failure (respiratory, renal, and MOF), and ARDS. For this patient group, ISS and APACHE II scores might be helpful for stratifying by mortality risk, and GCS might be a good predictor for survival.Öğe Predictive factors for acute kidney injury and amputation in crush injuries from the Kahramanmaraş earthquakes(Turkish Assoc Trauma Emergency Surgery, 2024) Koroglu, Muhammed; Karakaplan, Mustafa; Barakat, Mohammed; Ergen, Emre; Aslanturk, Okan; Ozdes, Huseyin Utku; Bicakcioglu, MuratBACKGROUND: Crush syndrome (CS) is characterized by high morbidity and mortality due to severe electrolyte disorders, circulatory dysfunction, and multiple organ failure, secondary to severe rhabdomyolysis and reperfusion injuries. Acute kidney injury (AKI) related to crush syndrome is one of the life -threatening complications and is the most frequent cause of death following earthquakes, other than trauma. We conducted a retrospective study to identify predictive parameters from clinical and laboratory data that aid in recognizing CS, assessing its severity, and evaluating acute kidney injury and amputation indications in patients. METHODS: We retrospectively evaluated the clinical data and laboratory follow-up of 33 patients treated for crush syndrome within the first two weeks following the February 6, 2023 earthquake. Patients who underwent surgery for crush syndrome but could not be followed post -surgery were excluded. Laboratory parameters were analyzed upon admission and then daily over an average seven-day follow-up. A p -value of <0.05 was considered statistically significant. Data analysis was performed using IBM SPSS Statistics 26.0 and R Studio software. RESULTS: Of the 33 patients, 17 were male and 16 were female. The incidence of AKI was 35.7%, 66.7%, and 100% in patients with injuries to one, two, and three extremities, respectively. A significant correlation was observed between total entrapment time and the duration of required dialysis days; AKI risk significantly increased with more than six hours of total entrapment time. Regarding the initial blood values upon hospital admission, a myoglobin level exceeding 2330 mg/dL demonstrated the highest sensitivity for predicting AKI. An initial uric acid level (>6.36 mg/dL) on admission had the highest specificity for predicting AKI. The initial myoglobin level (>3450 mg/dL) showed the highest sensitivity in predicting the need for amputation. Meanwhile, the mean creatine kinase (CK) level (>34800 U/L) exhibited the highest specificity but the lowest sensitivity for amputation prediction. CONCLUSION: The study analyzed the effectiveness and predictability of clinical and laboratory findings concerning amputation and acute kidney injury in crush syndrome resulting from earthquakes. Effective amputation management is a crucial factor influencing prognosis and survival in patients with earthquake -induced crush syndrome.Öğe Protective effects of quercetin against sepsis-induced oxidative damage on rat kidneys(Bayrakol Medical Publisher, 2022) Duran, Mehmet; Bicakcioglu, Murat; Yilmaz, Nezir; Turk, Bilge Aydin; Dogukan, Mevlut; Nakir, Hamza; Dogan, ZumrutAim: Sepsis is a clinical pathology, characterized by a severe and exaggerated inflammatory response. One of the most frequently damaged organs in sepsis is the kidney. Quercetin has anti-inflammatory, anti-proliferative, and antioxidant effects. In this study. it was aimed to examine the protective effects of quercetin on the kidneys. Material and Methods: In the scope of this study, 31 rats were planned to be used in the experiments. The groups and number of animals were as follows: Group 1:1.5 ml saline, Group 2: 1.5 ml olive oil, Group 3: intestinal ligation and puncture procedure was used to create experimental sepsis method. Group 4:20 mg/kg quercetin was administrated by gavage. Group 5: quercetin was administered in intragastrically at doses of 20 mg/kg. In biochemical analyzes of kidney tissue samples, BUN, creatinine, MDA and GSH values were checked. Cell damage, inflammation and fibrosis were evaluated histopathologically. Results: As a result of this study, tissue GSH levels were significantly different between groups 3 and 4 (p- 0.001). In terms of BUN value, it was found to be significantly higher in group 3 (p= 0.002). In tissue histology, glomerulitis (p, 0.001), tubular cell necrosis (p= 0.001) and mesenchymal matrix increase (p= 0.001) were different between groups 3 and 4. Finally, no fibrosis was observed in any group (p> 0.05). Discussion: Quercetin has protective effects on kidney tissue against organ damage caused by sepsis.Öğe Takayasu Arteritli Gebede Kombine Spinal Epidural Anestezi ile Sezaryen Operasyonu: Olgu Sunumu(2013) Gülhaş, Nurçin; Bicakcioglu, Murat; Aydoğan, Mustafa Sait; Durmuş, MahmutTakayasu arteriti, aort ve ana dallarını etkileyen idiopatik oldukça nadir görülen bir büyük damar vaskülitidir. Genellikle doğurganlık yaşındaki kadınlarda görülür. Tutulan damar alanına bağlı olarak görme bozuklukları, serebrovasküler yetersizlik bulguları, geçici iskemik atak, kollarda nabızların yokluğu gibi klinik bulguları vardır. Kollardan ölçülen kan basıncı değerlerinin iki kol arasında 10--20 mmHg'dan farklı olması hastalığı akla getirmelidir. Etiyolojisi bilinmeyen bu panarteritis türünde anestezi yönetiminde, kontrol edilemeyen hipertansiyon, hipertansiyona bağlı gelişen son organ hasarları ve arterial kan basıncındaki değişikleri kontrol etmede güçlüklerle karşılaşılabilir. Bu nedenle kombine spinal epidural anestezi ile acil sezayen operasyonu planlanan Takayasu arteritli 32 yaşındaki kadın hastada anestezik yönetimi sunmayı amaçladık. Anahtar Kelimeler: TakayasuÖğe Two-Stage Liver Transplantation: Three Clinical Scenerios.(Wiley-Blackwell, 2014) Gedik, Ender; Bicakcioglu, Murat; Otan, Emrah; Isik, Burak; Aydin, Cemalettin; Bayindir, Yasar; Toprak, Huseyin I.[Abstract Not Available]
