January 2019

Original Article

Prognostic value of natriuretic peptides in intensive care units

Saniye Goknil Calik1 , Mustafa Calik2 , Zerrin Defne Dundar3 , Basar Cander3

1 Department of Emergency and First Aid, KTO Karatay University Vocational School of Health, 2 Department of Thoracic Surgery, Health Sciences University, Konya Training and Research Hospital, 3 Department of Emergency Medicine, Necmettin Erbakan University Meram Faculty of Medicine, Konya, Turkey Natriuretic peptides in intensive care units Prognostic value of natriuretic peptides in intensive care units

DOI: 10.4328/AEMED.150

Abstract

Aim: In this study, we aimed to investigate the relationship between the values of atrial natriuretic peptide (ANP) and C-type natriuretic peptide (CNP) measured in the first 24 hours and the disease severity and prognostic value of the patients who underwent mechanical ventilation in the intensive care unit. Material and Method: Ninety-nine non-pregnant patients aged 18 years and older who underwent mechanical ventilation in the intensive care unit between 2011 and 2013 due to acute respiratory failure were included in this prospective study. Results: The study included 99 mechanically ventilated patients whose mean ages were 71.73 (18-105) years. Of the patients, 56 (56.6%) were male and 43 (43.4%) were female. Assessment of patients was carried out with the worst data recorded in the first 24 hours. There was no statistically significant difference between the groups in age, gender, and additional diseases (p=0.311, p=0.456, and p=0.820 respectively). When the survivors (n=75) and the non-survivors (n=24) were compared, the values of GCS, APACHE II and SOFA were significantly different (p=0.031, p<0.001, and p<0.001 respectively). The median ANP values were 303 (46-51536) – 230 (173-7370) (p = 0.148), and the median CNP values were 88 (0-4795) – 86 (4-203) (p = 0.419), respectively in survivors and non-survivors. Discussion: In our study, although a slight decrease was determined between the values of ANP and CNP measured, it wasn’t statistically significant. ANP and CNP can potentially determine the risk of death. It is still open to debate. Further researches are required for ANP and CNP in a longer time and in larger patient populations.

Keywords

Natriuretic Peptide; Ventilation; Intensive Care Units; GCS; APACHE II; SOFA

This case was presented as an oral presentation in the 3rd Intercontinental Emergency Medicine Congress, 3rd International Critical Care and Emergency Medicine Congress 19-22 May 2016 Antalya, Turkey 

Corresponding Author: Mustafa Calik, Department of Thoracic Surgery, Health Sciences University, Konya Training and Research Hospital, Meram, Konya, Turkey. GSM: +905058584898 T.: +90 3323236709 F.: +90 3323236723 E-Mail: drmcalik@hotmail.com

ORCID ID: 0000-0001-9963-5724

How to cite this article: Calik SG, Calik M, Dundar ZD, Cander B. Prognostic value of natriuretic peptides in intensive care units. J Ann Eu Med 2019;7(1): 11-4.

Does lunar cycle influence suicide attempts?

Murat Koyuncu1 , Ali Duman2 , Derya Ozturk3 , Guleser Akpinar4 , Bedia Gulen5 , Hatice Topcu6 , Serap Biberoglu7 , Hilal Hocagil8 , Fatih Esad Topal9 , Bedriye Müge Sonmez10

1 Department of Emergency Medicine, Bahat Hospital, Istanbul, 2 Department of Emergency Medicine, Adnan Menderes University, Faculty of Medicine, Aydın, 3 Department of Emergency Medicine, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, 4 Department of Emergency Medicine, Okmeydani Training and Research Hospital, Istanbul, 5 Department of Emergency Medicine, Bezmi Alem University, School of Medicine, Istanbul, 6 Department of Emergency Medicine, Bagcilar Training and Research Hospital, Istanbul, 7 Department of Emergency Medicine, Karabuk University, Faculty of Medicine, Karabuk, 8 Department of Emergency Medicine, Bulent Ecevit University, Faculty of Medicine, Zonguldak, 9 Department of Emergency Medicine, Izmir Katip Celebi University, School of Medicine, Izmir, 10Department of Emergency Medicine, Ankara Numune Training and Research Hospital, Istanbul, Turkey

DOI: 10.4328/AEMED.148

Abstract

Aim: Suicide is when a person intentionally ends his or her own life. Today, it is considered a global concern. It is important to address the underlying causes leading to suicides. In this study, we aimed to investigate the relationship between the lunar cycle and suicide attempts. Material and Method: This multicenter study was done retrospectively between January 1, 2012 and December 31, 2012. The records of patients who presented to emergency departments (EDs) with attempted suicide at nine different hospitals across the country were evaluated retrospectively. The lunar phases of the days when patients presented to the hospitals were also evaluated. Results: As determined by an investigation of the days of presentation of the 5,647 patients who were investigated, 25.28% of the patients presented during the first quarter, 25.71% during the full moon, 25.03% during the last quarter, and 23.68% during the new moon. There is, therefore, no significant difference observed between the lunar phases and suicidal attempts (P <0.05). Discussion: The results of the present study and the literature findings do not support the hypothesis of the lunar cycle having any effect on suicide attempts.

Keywords

Lunar Phases; Suicide; Emergency Department

Corresponding Author: Murat Koyuncu, Bahat Hospital, Acil Servis, Eski Edirne Asfaltı, No: 653 Sultangazi, İstanbul, Turkey. GSM: +905336596373 E-Mail: trmmuratk@gmail.com, trmuratk@hotmail.com

ORCID ID: 0000-0001-7446-1641

How to cite this article: Koyuncu M, Duman A, Ozturk D, Akpinar G, Gulen B, Topcu H, Biberoglu S, Hocagil H, Topal FE, Sonmez BM. Does lunar cycle influence suicide attempts? J Ann Eu Med 2019;7(1): 6-10.

Healthcare-associated infections in the pediatric intensive care unit: A 6-year evaluation

Zeliha Haytoglu1 , Ozlem Ozgur Gundeslioglu2 , Dincer Yildizdas3 , Emine Kocabas2 , Derya Alabaz2 , Aslihan Ulu Candevir4 , Ozden Ozgur Horoz3

1 Department of Pediatrics, 2 Department of Pediatrics, Division of Pediatric Infectious Diseases, 3 Department of Pediatrics, Division of Pediatric Critical Care, 4 Department of Infectious Diseases, Cukurova University, Faculty of Medicine, Adana, Turkey

DOI: 10.4328/AEMED.143

Abstract Aim: Identifying local determinants of the Healthcare-associated infections(HCAI) burden and improving reporting and surveillance systems is the first step to find active action programs against HCAI. The aim of this study was to evaluate and describe the results of surveillance of HCAIs in a Leve lIII intensive care unit( ICU ) between January 2011 and December 2016. Material and Method: Children aged between 28 days and 18 years with HCAI in the ICU were included in the study. The definition of HCAI was based on the 2008 CDC diagnostic criteria. Results: During 6 years7211 patients were admitted in the ICU. Infection rate was 12.6 infections per 1000 resident days. Between2011 and 2016, %60.3 reduction in the central line-associated bloodstream infections (CLABSI), 61.1% reduction in ventilatory-associated pneumonia (VAP) was observed.Prior to implementation of VAP bundle in 2013, the incidence of VAP was 10.7/1000 ventilator days. After the implementation of VAP bundle, 71.7% reduction was reported in VAP between 2013 and 2016. Of 342 infections, the most common infections were pneumonia (n=182, 53.2%), bloodstream infections(n=86, 25.2%) and urinary tract infections (n=62, 18.1%). A total of 435 infectious agents were isolated. Acinetobacter baumanni was the most commonly reported pathogen(25.05%) followed secondly by Klebsiella pneumoniae (17.01% ). Discussion: Surveillance data are useful to identify interventions needed and to assess the interventions to improve infection rates.Education of the health care providers, multidisciplinary team approach and strict criteria to define appropriate indications for the use of indwelling catheters, devices and strict adherence to bundles are vital to decrease the HCAI rates.

Keywords

Care Bundle; Catheter-Associated Urinary Tract Infection; Central Line-Associated Bloodstream Infections; Device-Associated Infections; Ventilator-Associated Pneumonia

Corresponding Author: Zeliha Haytoglu, Department of Pediatrics, Cukurova University, Faculty of Medicine , Adana, Turkey. GSM: +905052540485 E-Mail:zelihahayt@yahoo.com

ORCID ID: 0000-0002-8371-5137

How to cite this article: Haytoglu Z, Gundeslioglu OO, Yildizdas D, Kocabas E, Alabaz D, Candevir ÜU, Horoz OO. Healthcare-associated infections in the pediatric intensive care unit: A 6-year evaluation. J Ann Eu Med 2019;7(1): 1-5.

Original Image

Aberrant internal carotid artery presenting as oropharyngeal mass

Anup Singh1 , Arvind Kumar Kairo2 , Namrita Mehmi2

1 Department of Otolaryngology and Head & Neck Surgery, Medanta-The Medicity, Gurugram, Haryana, 2 Department of Otolaryngology and Head & Neck Surgery, All India Institute of Medical Sciences, New Delhi, India

DOI:10.4328/AEMED.147

A 52 years old male presented to us with complaints of throat discomfort and foreign body sensation for 2 years. The patient did not report of any other upper aerodigestive tract symptoms. There was no history of addiction or any other comorbidities and patient was in a good general state of health. On examination, the patient was found to have a globular pulsatile, non-tender swelling involving left side oropharynx and tonsillar fossa region. On laryngoscopic examination, endolarynx was found to be within normal limits. The general systemic examination was within normal limits. A contrast-enhanced CT scan was ordered and showed a markedly tortuous internal carotid artery on the left side reaching till midline (Figure 1). The patient was reassured after explaining the condition and advised for further follow up as needed. The ICA normally rotates gradually and smoothly, first laterally and then posteromedially in relation to the ECA after its origin from the carotid bifurcation and then runs a straight course to the carotid canal [1]. The normal tonsillo-carotid distance varies with age and is usually around 25 mm in adults [2]. Pronounced anatomical aberrations involving the extracranial internal carotid artery (ICA) have been described to be present in 5-6% of the general population [3]. The significance of such occurrence resides in clinical symptomatology from positional central hypoperfusion or surgical risk from pharyngeal/ neck surgeries, although they are asymptomatic in up to 80% of cases [3]. These aberrations have been classified anatomically (tortuosity, kinking or coiling) [4,5] and clinico-radiologically (depending on the distance of ICA from the pharyngeal wall) [1]. Utmost care needs to be exercised with careful visual and palpatory examination before undertaking diagnostic and therapeutic ventures of the pharyngeal cavity.

References 1. Leipzig TJ, Dohrmann GJ. The tortuous or kinked carotid artery: Pathogenesis and clinical considerations. Surg Neurol. 1986; 25: 478-86. 2. Tillmann B, Christofides C. The “dangerous loop” of the internal carotid artery. An anatomic study. HNO. 1995; 43: 601-4. 3. Pfeiffer J, Ridder GJ. A clinical classification system for aberrant internal carotid arteries. Laryngoscope. 2008; 118: 1931-6. 4. Metz H, Murray-Leslie RM, Bannister RG, Bull JW, Marshall J. Kinking of the internal carotid artery. Lancet. 1961; 1: 424-6. 5. Weibel J, Fields WS. Tortuosity, coiling, and kinking of the internal carotid artery. I. Etiology and radiographic anatomy. Neurology. 1965; 15: 7-18.

Corresponding Author: Anup Singh, Dept. of Otolaryngology and Head & Neck Surgery, Medanta-The Medicity, Gurugram, Haryana, India. T.: 9811990085 E-Mail: anoop.aiims1@gmail.com

ORCID ID: 0000-0001-9893-7106