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Smit JM, Exterkate L, van Tienhoven AJ, Haaksma ME, Heldeweg MLA, Fleuren L, Thoral P, Dam TA, Heunks LMA, Gommers D, Cremer OL, Bosman RJ, Rigter S, Wils EJ, Frenzel T, Vlaar AP, Dongelmans DA, de Jong R, Peters M, Kamps MJA, Ramnarain D, Nowitzky R, Nooteboom FGCA, de Ruijter W, Urlings-Strop LC, Smit EGM, Mehagnoul-Schipper DJ, Dormans T, de Jager CPC, Hendriks SHA, Achterberg S, Oostdijk E, Reidinga AC, Festen-Spanjer B, Brunnekreef GB, Cornet AD, van den Tempel W, Boelens AD, Koetsier P, Lens J, Faber HJ, Karakus A, Entjes R, de Jong P, Rettig TCD, Arbous S, Vonk B, Machado T, Girbes ARJ, Sieswerda E, Elbers PWG, Tuinman PR. INCIDENCE, RISK FACTORS, AND OUTCOME OF SUSPECTED CENTRAL VENOUS CATHETER-RELATED INFECTIONS IN CRITICALLY ILL COVID-19 PATIENTS: A MULTICENTER RETROSPECTIVE COHORT STUDY. Shock 2022; 58:358-365. [PMID: 36155964 DOI: 10.1097/shk.0000000000001994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
ABSTRACT Background: Aims of this study were to investigate the prevalence and incidence of catheter-related infection, identify risk factors, and determine the relation of catheter-related infection with mortality in critically ill COVID-19 patients. Methods: This was a retrospective cohort study of central venous catheters (CVCs) in critically ill COVID-19 patients. Eligible CVC insertions required an indwelling time of at least 48 hours and were identified using a full-admission electronic health record database. Risk factors were identified using logistic regression. Differences in survival rates at day 28 of follow-up were assessed using a log-rank test and proportional hazard model. Results: In 538 patients, a total of 914 CVCs were included. Prevalence and incidence of suspected catheter-related infection were 7.9% and 9.4 infections per 1,000 catheter indwelling days, respectively. Prone ventilation for more than 5 days was associated with increased risk of suspected catheter-related infection; odds ratio, 5.05 (95% confidence interval 2.12-11.0). Risk of death was significantly higher in patients with suspected catheter-related infection (hazard ratio, 1.78; 95% confidence interval, 1.25-2.53). Conclusions: This study shows that in critically ill patients with COVID-19, prevalence and incidence of suspected catheter-related infection are high, prone ventilation is a risk factor, and mortality is higher in case of catheter-related infection.
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Affiliation(s)
| | - Lotte Exterkate
- Department of Intensive Care Medicine, Research VUmc Intensive Care (REVIVE), Amsterdam Medical Data Science (AMDS), Amsterdam Institute for Infection and Immunity (AII) and Amsterdam Cardiovascular Sciences (ACS), Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands
| | | | | | | | - Lucas Fleuren
- Department of Intensive Care Medicine, Research VUmc Intensive Care (REVIVE), Amsterdam Medical Data Science (AMDS), Amsterdam Institute for Infection and Immunity (AII) and Amsterdam Cardiovascular Sciences (ACS), Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands
| | - Patrick Thoral
- Department of Intensive Care Medicine, Research VUmc Intensive Care (REVIVE), Amsterdam Medical Data Science (AMDS), Amsterdam Institute for Infection and Immunity (AII) and Amsterdam Cardiovascular Sciences (ACS), Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands
| | - Tariq A Dam
- Department of Intensive Care Medicine, Research VUmc Intensive Care (REVIVE), Amsterdam Medical Data Science (AMDS), Amsterdam Institute for Infection and Immunity (AII) and Amsterdam Cardiovascular Sciences (ACS), Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands
| | - Leo M A Heunks
- Department of Intensive Care, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Diederik Gommers
- Department of Intensive Care, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Olaf L Cremer
- Intensive Care, UMC Utrecht, Utrecht, the Netherlands
| | | | - Sander Rigter
- Department of Anesthesiology and Intensive Care, St Antonius Hospital, Nieuwegein, the Netherlands
| | - Evert-Jan Wils
- Department of Intensive Care, Franciscus Gasthuis and Vlietland, Rotterdam, the Netherlands
| | - Tim Frenzel
- Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Alexander P Vlaar
- Department of Intensive Care Medicine, Amsterdam UMC, Amsterdam, the Netherlands
| | - Dave A Dongelmans
- Department of Intensive Care Medicine, Amsterdam UMC, Amsterdam, the Netherlands
| | - Remko de Jong
- Intensive Care, Bovenij Ziekenhuis, Amsterdam, the Netherlands
| | - Marco Peters
- Intensive Care, Canisius Wilhelmina Ziekenhuis, Nijmegen, the Netherlands
| | - Marlijn J A Kamps
- Intensive Care, Catharina Ziekenhuis Eindhoven, Eindhoven, the Netherlands
| | | | - Ralph Nowitzky
- Intensive Care, HagaZiekenhuis, Den Haag, the Netherlands
| | | | - Wouter de Ruijter
- Department of Intensive Care Medicine, Northwest Clinics, Alkmaar, the Netherlands
| | | | - Ellen G M Smit
- Intensive Care, Spaarne Gasthuis, Haarlem en Hoofddorp, the Netherlands
| | | | - Tom Dormans
- Intensive care, Zuyderland MC, Heerlen, the Netherlands
| | | | | | | | | | - Auke C Reidinga
- ICU, SEH, BWC, Martiniziekenhuis, Groningen, the Netherlands
| | | | - Gert B Brunnekreef
- Department of Intensive Care, Ziekenhuisgroep Twente, Almelo, the Netherlands
| | - Alexander D Cornet
- Department of Intensive Care, Medisch Spectrum Twente, Enschede, the Netherlands
| | - Walter van den Tempel
- Department of Intensive Care, Ikazia Ziekenhuis Rotterdam, Rotterdam, the Netherlands
| | - Age D Boelens
- Anesthesiology, Antonius Ziekenhuis Sneek, Sneek, the Netherlands
| | - Peter Koetsier
- Intensive Care, Medisch Centrum Leeuwarden, Leeuwarden, the Netherlands
| | - Judith Lens
- ICU, IJsselland Ziekenhuis, Capelle aan den IJssel, the Netherlands
| | | | - A Karakus
- Department of Intensive Care, Diakonessenhuis Hospital, Utrecht, the Netherlands
| | - Robert Entjes
- Department of Intensive Care, Adrz, Goes, the Netherlands
| | - Paul de Jong
- Department of Anesthesia and Intensive Care, Slingeland Ziekenhuis, Doetinchem, the Netherlands
| | - Thijs C D Rettig
- Department of Anesthesiology, Intensive Care and Pain Medicine, Amphia Ziekenhuis, Breda, the Netherlands
| | - Sesmu Arbous
- Department of Intensive Care, LUMC, Leiden, the Netherlands
| | - Bas Vonk
- Pacmed, Amsterdam, the Netherlands
| | | | - Armand R J Girbes
- Department of Intensive Care Medicine, Research VUmc Intensive Care (REVIVE), Amsterdam Medical Data Science (AMDS), Amsterdam Institute for Infection and Immunity (AII) and Amsterdam Cardiovascular Sciences (ACS), Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands
| | - Elske Sieswerda
- Department of Medical Microbiology, University Medical Centre Utrecht, University of Utrecht, Utrecht, the Netherlands
| | - Paul W G Elbers
- Department of Intensive Care Medicine, Research VUmc Intensive Care (REVIVE), Amsterdam Medical Data Science (AMDS), Amsterdam Institute for Infection and Immunity (AII) and Amsterdam Cardiovascular Sciences (ACS), Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands
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Dam TA, Roggeveen LF, van Diggelen F, Fleuren LM, Jagesar AR, Otten M, de Vries HJ, Gommers D, Cremer OL, Bosman RJ, Rigter S, Wils EJ, Frenzel T, Dongelmans DA, de Jong R, Peters MAA, Kamps MJA, Ramnarain D, Nowitzky R, Nooteboom FGCA, de Ruijter W, Urlings-Strop LC, Smit EGM, Mehagnoul-Schipper DJ, Dormans T, de Jager CPC, Hendriks SHA, Achterberg S, Oostdijk E, Reidinga AC, Festen-Spanjer B, Brunnekreef GB, Cornet AD, van den Tempel W, Boelens AD, Koetsier P, Lens J, Faber HJ, Karakus A, Entjes R, de Jong P, Rettig TCD, Arbous S, Vonk SJJ, Machado T, Herter WE, de Grooth HJ, Thoral PJ, Girbes ARJ, Hoogendoorn M, Elbers PWG. Predicting responders to prone positioning in mechanically ventilated patients with COVID-19 using machine learning. Ann Intensive Care 2022; 12:99. [PMID: 36264358 PMCID: PMC9583049 DOI: 10.1186/s13613-022-01070-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 10/06/2022] [Indexed: 11/24/2022] Open
Abstract
Background For mechanically ventilated critically ill COVID-19 patients, prone positioning has quickly become an important treatment strategy, however, prone positioning is labor intensive and comes with potential adverse effects. Therefore, identifying which critically ill intubated COVID-19 patients will benefit may help allocate labor resources. Methods From the multi-center Dutch Data Warehouse of COVID-19 ICU patients from 25 hospitals, we selected all 3619 episodes of prone positioning in 1142 invasively mechanically ventilated patients. We excluded episodes longer than 24 h. Berlin ARDS criteria were not formally documented. We used supervised machine learning algorithms Logistic Regression, Random Forest, Naive Bayes, K-Nearest Neighbors, Support Vector Machine and Extreme Gradient Boosting on readily available and clinically relevant features to predict success of prone positioning after 4 h (window of 1 to 7 h) based on various possible outcomes. These outcomes were defined as improvements of at least 10% in PaO2/FiO2 ratio, ventilatory ratio, respiratory system compliance, or mechanical power. Separate models were created for each of these outcomes. Re-supination within 4 h after pronation was labeled as failure. We also developed models using a 20 mmHg improvement cut-off for PaO2/FiO2 ratio and using a combined outcome parameter. For all models, we evaluated feature importance expressed as contribution to predictive performance based on their relative ranking. Results The median duration of prone episodes was 17 h (11–20, median and IQR, N = 2632). Despite extensive modeling using a plethora of machine learning techniques and a large number of potentially clinically relevant features, discrimination between responders and non-responders remained poor with an area under the receiver operator characteristic curve of 0.62 for PaO2/FiO2 ratio using Logistic Regression, Random Forest and XGBoost. Feature importance was inconsistent between models for different outcomes. Notably, not even being a previous responder to prone positioning, or PEEP-levels before prone positioning, provided any meaningful contribution to predicting a successful next proning episode. Conclusions In mechanically ventilated COVID-19 patients, predicting the success of prone positioning using clinically relevant and readily available parameters from electronic health records is currently not feasible. Given the current evidence base, a liberal approach to proning in all patients with severe COVID-19 ARDS is therefore justified and in particular regardless of previous results of proning. Supplementary Information The online version contains supplementary material available at 10.1186/s13613-022-01070-0.
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Affiliation(s)
- Tariq A Dam
- Department of Intensive Care Medicine, Laboratory for Critical Care Computational Intelligence, Amsterdam Medical Data Science, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands.
| | - Luca F Roggeveen
- Department of Intensive Care Medicine, Laboratory for Critical Care Computational Intelligence, Amsterdam Medical Data Science, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Fuda van Diggelen
- Quantitative Data Analytics Group, Department of Computer Science, Faculty of Science, VU University, Amsterdam, The Netherlands
| | - Lucas M Fleuren
- Department of Intensive Care Medicine, Laboratory for Critical Care Computational Intelligence, Amsterdam Medical Data Science, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Ameet R Jagesar
- Department of Intensive Care Medicine, Laboratory for Critical Care Computational Intelligence, Amsterdam Medical Data Science, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Martijn Otten
- Department of Intensive Care Medicine, Laboratory for Critical Care Computational Intelligence, Amsterdam Medical Data Science, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Heder J de Vries
- Department of Intensive Care Medicine, Laboratory for Critical Care Computational Intelligence, Amsterdam Medical Data Science, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Diederik Gommers
- Department of Intensive Care, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Olaf L Cremer
- Intensive Care, UMC Utrecht, Utrecht, The Netherlands
| | | | - Sander Rigter
- Department of Anesthesiology and Intensive Care, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Evert-Jan Wils
- Department of Intensive Care, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
| | - Tim Frenzel
- Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Dave A Dongelmans
- Department of Intensive Care Medicine, Amsterdam UMC, Amsterdam, The Netherlands
| | - Remko de Jong
- Intensive Care, Bovenij Ziekenhuis, Amsterdam, The Netherlands
| | - Marco A A Peters
- Intensive Care, Canisius Wilhelmina Ziekenhuis, Nijmegen, The Netherlands
| | - Marlijn J A Kamps
- Intensive Care, Catharina Ziekenhuis Eindhoven, Eindhoven, The Netherlands
| | | | - Ralph Nowitzky
- Intensive Care, HagaZiekenhuis, Den Haag, The Netherlands
| | | | - Wouter de Ruijter
- Department of Intensive Care Medicine, Northwest Clinics, Alkmaar, The Netherlands
| | | | - Ellen G M Smit
- Intensive Care, Spaarne Gasthuis, Haarlem en Hoofddorp, The Netherlands
| | | | - Tom Dormans
- Intensive Care, Zuyderland MC, Heerlen, The Netherlands
| | | | | | | | | | - Auke C Reidinga
- ICU, SEH, BWC, Martiniziekenhuis, Groningen, The Netherlands
| | | | - Gert B Brunnekreef
- Department of Intensive Care, Ziekenhuisgroep Twente, Almelo, The Netherlands
| | - Alexander D Cornet
- Department of Intensive Care, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Walter van den Tempel
- Department of Intensive Care, Ikazia Ziekenhuis Rotterdam, Rotterdam, The Netherlands
| | | | - Peter Koetsier
- Intensive Care, Medisch Centrum Leeuwarden, Leeuwarden, The Netherlands
| | - Judith Lens
- ICU, IJsselland Ziekenhuis, Capelle aan den IJssel, The Netherlands
| | | | - A Karakus
- Department of Intensive Care, Diakonessenhuis Hospital, Utrecht, The Netherlands
| | - Robert Entjes
- Department of Intensive Care, Adrz, Goes, The Netherlands
| | - Paul de Jong
- Department of Anesthesia and Intensive Care, Slingeland Ziekenhuis, Doetinchem, The Netherlands
| | - Thijs C D Rettig
- Department of Anesthesiology, Intensive Care and Pain Medicine, Amphia Ziekenhuis, Breda, The Netherlands
| | | | | | | | | | - Harm-Jan de Grooth
- Department of Intensive Care Medicine, Laboratory for Critical Care Computational Intelligence, Amsterdam Medical Data Science, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Patrick J Thoral
- Department of Intensive Care Medicine, Laboratory for Critical Care Computational Intelligence, Amsterdam Medical Data Science, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Armand R J Girbes
- Department of Intensive Care Medicine, Laboratory for Critical Care Computational Intelligence, Amsterdam Medical Data Science, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Mark Hoogendoorn
- Quantitative Data Analytics Group, Department of Computer Science, Faculty of Science, VU University, Amsterdam, The Netherlands
| | - Paul W G Elbers
- Department of Intensive Care Medicine, Laboratory for Critical Care Computational Intelligence, Amsterdam Medical Data Science, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
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3
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Uguz B, Oztas S, Zengin I, Topal D, Tiryakioglu SK, Yilmaztepe MA, Karakus A. Relationship between vitamin D deficiency and thrombus load in patients with ST-elevation myocardial infarction. Eur Rev Med Pharmacol Sci 2022; 26:7015-7023. [PMID: 36263549 DOI: 10.26355/eurrev_202210_29885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
OBJECTIVE Clinical studies detecting the increase in thrombotic events with vitamin D deficiency note the relationship between vitamin D and thrombosis. This study aims at evaluating the relationship between serum vitamin D levels and coronary thrombus burden. PATIENTS AND METHODS We retrospectively evaluated 77 patients with ST-elevated myocardial infarction (STEMI). Serum vitamin D levels, degree of coronary thrombus, Thrombolysis in Myocardial Infarction (TIMI) frame count and the extent and severity of atherosclerosis in coronary arteries were also measured in all cases. Patients were divided into 2 groups, according to thrombus load. RESULTS The rate of vitamin D deficiency in the study population was 79.22% (< 20 ng/mL). Vitamin D levels were significantly higher in patients with a mild thrombus load than in patients with a severe thrombus load (16 vs. 13.95 p = 0.018). Gensini scores were significantly higher in patients with a severe thrombus burden than in patients with a mild thrombus burden (42 vs. 54.5 p = 0.014). There was a low negative correlation between vitamin D levels and thrombus burden classification grades (r = -0.304, p = 0.007), Cx TIMI frame counts (r = -0.402, p < 0.001), and RCA TIMI frame counts (r = -0.479, p < 0.001). There was a moderate negative correlation between serum vitamin D levels and LAD TIMI frame count (r = -0.507, p < 0.001). CONCLUSIONS The results of our study showed that low 25(OH)D3 levels are an independent predictor of high coronary artery thrombus load and post-procedural TIMI frame count increase in patients with STEMI undergoing primary percutaneous coronary intervention.
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Affiliation(s)
- B Uguz
- Department of Cardiology, Bursa City Hospital, Bursa, Turkey.
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4
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Vagliano I, Schut MC, Abu-Hanna A, Dongelmans DA, de Lange DW, Gommers D, Cremer OL, Bosman RJ, Rigter S, Wils EJ, Frenzel T, de Jong R, Peters MAA, Kamps MJA, Ramnarain D, Nowitzky R, Nooteboom FGCA, de Ruijter W, Urlings-Strop LC, Smit EGM, Mehagnoul-Schipper DJ, Dormans T, de Jager CPC, Hendriks SHA, Achterberg S, Oostdijk E, Reidinga AC, Festen-Spanjer B, Brunnekreef GB, Cornet AD, van den Tempel W, Boelens AD, Koetsier P, Lens J, Faber HJ, Karakus A, Entjes R, de Jong P, Rettig TCD, Reuland MC, Arbous S, Fleuren LM, Dam TA, Thoral PJ, Lalisang RCA, Tonutti M, de Bruin DP, Elbers PWG, de Keizer NF. Assess and validate predictive performance of models for in-hospital mortality in COVID-19 patients: A retrospective cohort study in the Netherlands comparing the value of registry data with high-granular electronic health records. Int J Med Inform 2022; 167:104863. [PMID: 36162166 PMCID: PMC9492397 DOI: 10.1016/j.ijmedinf.2022.104863] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 08/19/2022] [Accepted: 09/03/2022] [Indexed: 11/17/2022]
Abstract
PURPOSE To assess, validate and compare the predictive performance of models for in-hospital mortality of COVID-19 patients admitted to the intensive care unit (ICU) over two different waves of infections. Our models were built with high-granular Electronic Health Records (EHR) data versus less-granular registry data. METHODS Observational study of all COVID-19 patients admitted to 19 Dutch ICUs participating in both the national quality registry National Intensive Care Evaluation (NICE) and the EHR-based Dutch Data Warehouse (hereafter EHR). Multiple models were developed on data from the first 24 h of ICU admissions from February to June 2020 (first COVID-19 wave) and validated on prospective patients admitted to the same ICUs between July and December 2020 (second COVID-19 wave). We assessed model discrimination, calibration, and the degree of relatedness between development and validation population. Coefficients were used to identify relevant risk factors. RESULTS A total of 1533 patients from the EHR and 1563 from the registry were included. With high granular EHR data, the average AUROC was 0.69 (standard deviation of 0.05) for the internal validation, and the AUROC was 0.75 for the temporal validation. The registry model achieved an average AUROC of 0.76 (standard deviation of 0.05) in the internal validation and 0.77 in the temporal validation. In the EHR data, age, and respiratory-system related variables were the most important risk factors identified. In the NICE registry data, age and chronic respiratory insufficiency were the most important risk factors. CONCLUSION In our study, prognostic models built on less-granular but readily-available registry data had similar performance to models built on high-granular EHR data and showed similar transportability to a prospective COVID-19 population. Future research is needed to verify whether this finding can be confirmed for upcoming waves.
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Affiliation(s)
- Iacopo Vagliano
- Department of Medical Informatics, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.
| | - Martijn C Schut
- Department of Medical Informatics, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Ameen Abu-Hanna
- Department of Medical Informatics, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Dave A Dongelmans
- National Intensive Care Evaluation (NICE) foundation, Amsterdam, The Netherlands; Department of Intensive Care Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Dylan W de Lange
- National Intensive Care Evaluation (NICE) foundation, Amsterdam, The Netherlands; Department of Intensive Care Medicine, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands
| | - Diederik Gommers
- Department of Intensive Care, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Olaf L Cremer
- Intensive Care, UMC Utrecht, Utrecht, The Netherlands
| | | | - Sander Rigter
- Department of Anesthesiology and Intensive Care, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Evert-Jan Wils
- Department of Intensive Care, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
| | - Tim Frenzel
- Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Remko de Jong
- Intensive Care, Bovenij Ziekenhuis, Amsterdam, The Netherlands
| | - Marco A A Peters
- Intensive Care, Canisius Wilhelmina Ziekenhuis, Nijmegen, The Netherlands
| | - Marlijn J A Kamps
- Intensive Care, Catharina Ziekenhuis Eindhoven, Eindhoven, The Netherlands
| | | | - Ralph Nowitzky
- Intensive Care, Haga Ziekenhuis, Den Haag, The Netherlands
| | | | - Wouter de Ruijter
- Department of Intensive Care Medicine, Northwest Clinics, Alkmaar, The Netherlands
| | | | - Ellen G M Smit
- Intensive Care, Spaarne Gasthuis, Haarlem en Hoofddorp, The Netherlands
| | | | - Tom Dormans
- Intensive care, Zuyderland MC, Heerlen, The Netherlands
| | | | | | | | | | - Auke C Reidinga
- ICU, SEH, BWC, Martiniziekenhuis, Groningen, The Netherlands
| | | | - Gert B Brunnekreef
- Department of Intensive Care, Ziekenhuisgroep Twente, Almelo, The Netherlands
| | - Alexander D Cornet
- Department of Intensive Care, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Walter van den Tempel
- Department of Intensive Care, Ikazia Ziekenhuis Rotterdam, Rotterdam, The Netherlands
| | - Age D Boelens
- Anesthesiology, Antonius Ziekenhuis Sneek, Sneek, The Netherlands
| | - Peter Koetsier
- Intensive Care, Medisch Centrum Leeuwarden, Leeuwarden, The Netherlands
| | - Judith Lens
- ICU, IJsselland Ziekenhuis, Capelle aan den IJssel, The Netherlands
| | | | - A Karakus
- Department of Intensive Care, Diakonessenhuis Hospital, Utrecht, The Netherlands
| | - Robert Entjes
- Department of Intensive Care, Adrz, Goes, The Netherlands
| | - Paul de Jong
- Department of Anesthesia and Intensive Care, Slingeland Ziekenhuis, Doetinchem, The Netherlands
| | - Thijs C D Rettig
- Department of Anesthesiology, Intensive Care and Pain Medicine, Amphia Ziekenhuis, Breda, The Netherlands
| | - M C Reuland
- Department of Medical Informatics, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | | | - Lucas M Fleuren
- Department of Intensive Care Medicine, Laboratory for Critical Care Computational Intelligence, Amsterdam Medical Data Science, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Tariq A Dam
- Department of Intensive Care Medicine, Laboratory for Critical Care Computational Intelligence, Amsterdam Medical Data Science, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Patrick J Thoral
- Department of Intensive Care Medicine, Laboratory for Critical Care Computational Intelligence, Amsterdam Medical Data Science, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | | | | | | | - Paul W G Elbers
- Department of Intensive Care Medicine, Laboratory for Critical Care Computational Intelligence, Amsterdam Medical Data Science, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Nicolette F de Keizer
- Department of Medical Informatics, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands; National Intensive Care Evaluation (NICE) foundation, Amsterdam, The Netherlands
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5
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Tutuncu A, Camci S, Karakus A, Bursa N, Kinik M, Zengin I, Severgun K, Demir M, Ari H. A novel intermediate coronary artery stenosis severity method: Fluoroscopy-Assisted Measurement of Coronary Volume Ratio (The FLAME FFR Trial). Eur Rev Med Pharmacol Sci 2022; 26:1101-1107. [PMID: 35253164 DOI: 10.26355/eurrev_202202_28099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE The fluoroscopy-assisted coronary volume measurement (FLASH) algorithm, based on contrast passage time and vessel size, is a simple and non-invasive method of assessing coronary blood volume. The present study evaluated the diagnostic performance of FLASH flow ratio-derived fractional flow reserve (FFRFLAME) compared to wire-based FFR (FFRWB). PATIENTS AND METHODS FFRFLAME was defined as the ratio of FLASH at baseline to maximal hyperemia. Forty-eight patients with one intermediate coronary lesion (30-70% by angiographic visual estimation) were enrolled in this cross-sectional study. FFRFLAME and FFRWB measurements were collected in each patient. Intravenous administration of adenosine was used to achieve maximal hyperemia. The Pearson correlation coefficient and receiver operating characteristic analysis were performed to determine the predictive accuracy of FFRFLAME. RESULTS The average age of the patients was 58 years, and 43% (21 of 48) were female. The predominant vessel assessed was the left anterior descending artery system (87.5%). The mean FFRWB was 0.91 ± 0.05 at baseline and 0.83 ± 0.07 at the hyperaemic level, with 27% (13 of 48) of patients having an FFRWB of ≤0.80. For each patient, the mean FFRFLAME was 0.668 ± 0.17. The mean FFRFLAME was 0.85 ± 0.16 for patients having an FFRWB of ≤0.80. A strong relationship existed between FFRFLAME and FFRWB (Pearson's r = - 0.765 p<0.001). The optimal cutoff value of the functional significance of coronary artery stenosis for FFRFLAME was determined to be > 0.84 (AUC: 0.899, 84% sensitivity and 97% specificity) when the FFRWB cutoff value for significant lesions was ≤ 0.80. CONCLUSIONS FFRFLAME, applied to coronary angiography without the need for an invasive pressure wire, can be a beneficial index for appropriate lesion selection in coronary artery diseases.
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Affiliation(s)
- A Tutuncu
- Department of Cardiology, University of Health Sciences, Bursa Postgraduate Hospital Bursa, Turkey.
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Fleuren LM, Dam TA, Tonutti M, de Bruin DP, Lalisang RCA, Gommers D, Cremer OL, Bosman RJ, Rigter S, Wils EJ, Frenzel T, Dongelmans DA, de Jong R, Peters M, Kamps MJA, Ramnarain D, Nowitzky R, Nooteboom FGCA, de Ruijter W, Urlings-Strop LC, Smit EGM, Mehagnoul-Schipper DJ, Dormans T, de Jager CPC, Hendriks SHA, Achterberg S, Oostdijk E, Reidinga AC, Festen-Spanjer B, Brunnekreef GB, Cornet AD, van den Tempel W, Boelens AD, Koetsier P, Lens J, Faber HJ, Karakus A, Entjes R, de Jong P, Rettig TCD, Arbous S, Vonk SJJ, Fornasa M, Machado T, Houwert T, Hovenkamp H, Noorduijn Londono R, Quintarelli D, Scholtemeijer MG, de Beer AA, Cinà G, Kantorik A, de Ruijter T, Herter WE, Beudel M, Girbes ARJ, Hoogendoorn M, Thoral PJ, Elbers PWG. Predictors for extubation failure in COVID-19 patients using a machine learning approach. Crit Care 2021; 25:448. [PMID: 34961537 PMCID: PMC8711075 DOI: 10.1186/s13054-021-03864-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 12/13/2021] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Determining the optimal timing for extubation can be challenging in the intensive care. In this study, we aim to identify predictors for extubation failure in critically ill patients with COVID-19. METHODS We used highly granular data from 3464 adult critically ill COVID patients in the multicenter Dutch Data Warehouse, including demographics, clinical observations, medications, fluid balance, laboratory values, vital signs, and data from life support devices. All intubated patients with at least one extubation attempt were eligible for analysis. Transferred patients, patients admitted for less than 24 h, and patients still admitted at the time of data extraction were excluded. Potential predictors were selected by a team of intensive care physicians. The primary and secondary outcomes were extubation without reintubation or death within the next 7 days and within 48 h, respectively. We trained and validated multiple machine learning algorithms using fivefold nested cross-validation. Predictor importance was estimated using Shapley additive explanations, while cutoff values for the relative probability of failed extubation were estimated through partial dependence plots. RESULTS A total of 883 patients were included in the model derivation. The reintubation rate was 13.4% within 48 h and 18.9% at day 7, with a mortality rate of 0.6% and 1.0% respectively. The grandient-boost model performed best (area under the curve of 0.70) and was used to calculate predictor importance. Ventilatory characteristics and settings were the most important predictors. More specifically, a controlled mode duration longer than 4 days, a last fraction of inspired oxygen higher than 35%, a mean tidal volume per kg ideal body weight above 8 ml/kg in the day before extubation, and a shorter duration in assisted mode (< 2 days) compared to their median values. Additionally, a higher C-reactive protein and leukocyte count, a lower thrombocyte count, a lower Glasgow coma scale and a lower body mass index compared to their medians were associated with extubation failure. CONCLUSION The most important predictors for extubation failure in critically ill COVID-19 patients include ventilatory settings, inflammatory parameters, neurological status, and body mass index. These predictors should therefore be routinely captured in electronic health records.
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Affiliation(s)
- Lucas M. Fleuren
- Department of Intensive Care Medicine, Laboratory for Critical Care Computational Intelligence, Amsterdam Medical Data Science, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Tariq A. Dam
- Department of Intensive Care Medicine, Laboratory for Critical Care Computational Intelligence, Amsterdam Medical Data Science, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | | | | | | | - Diederik Gommers
- Department of Intensive Care, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Olaf L. Cremer
- Department of Intensive Care, UMC Utrecht, Utrecht, The Netherlands
| | | | - Sander Rigter
- Department of Anesthesiology and Intensive Care, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Evert-Jan Wils
- Department of Intensive Care, Franciscus Gasthuis and Vlietland, Rotterdam, The Netherlands
| | - Tim Frenzel
- Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Dave A. Dongelmans
- Department of Intensive Care Medicine, Amsterdam UMC, Amsterdam, The Netherlands
| | - Remko de Jong
- Intensive Care, Bovenij Ziekenhuis, Amsterdam, The Netherlands
| | - Marco Peters
- Intensive Care, Canisius Wilhelmina Ziekenhuis, Nijmegen, The Netherlands
| | | | | | - Ralph Nowitzky
- Intensive Care, HagaZiekenhuis, Den Haag, The Netherlands
| | | | - Wouter de Ruijter
- Department of Intensive Care Medicine, Northwest Clinics, Alkmaar, The Netherlands
| | | | - Ellen G. M. Smit
- Intensive Care, Spaarne Gasthuis, Haarlem en Hoofddorp, The Netherlands
| | | | - Tom Dormans
- Intensive Care, Zuyderland MC, Heerlen, The Netherlands
| | | | | | | | | | | | | | - Gert B. Brunnekreef
- Department of Intensive Care, Ziekenhuisgroep Twente, Almelo, The Netherlands
| | - Alexander D. Cornet
- Department of Intensive Care, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Walter van den Tempel
- Department of Intensive Care, Ikazia Ziekenhuis Rotterdam, Rotterdam, The Netherlands
| | | | - Peter Koetsier
- Intensive Care, Medisch Centrum Leeuwarden, Leeuwarden, The Netherlands
| | - Judith Lens
- ICU, IJsselland Ziekenhuis, Capelle Aan Den IJssel, The Netherlands
| | | | - A. Karakus
- Department of Intensive Care, Diakonessenhuis Hospital, Utrecht, The Netherlands
| | - Robert Entjes
- Department of Intensive Care, Adrz, Goes, The Netherlands
| | - Paul de Jong
- Department of Anesthesia and Intensive Care, Slingeland Ziekenhuis, Doetinchem, The Netherlands
| | - Thijs C. D. Rettig
- Department of Anesthesiology, Intensive Care and Pain Medicine, Amphia Ziekenhuis, Breda, The Netherlands
| | - Sesmu Arbous
- Department of Intensive Care, LUMC, Leiden, The Netherlands
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Martijn Beudel
- Department of Neurology, Amsterdam UMC, Universiteit Van Amsterdam, Amsterdam, The Netherlands
| | - Armand R. J. Girbes
- Department of Intensive Care Medicine, Laboratory for Critical Care Computational Intelligence, Amsterdam Medical Data Science, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Mark Hoogendoorn
- Quantitative Data Analytics Group, Department of Computer Science, Faculty of Science, Vrije Universiteit, Amsterdam, The Netherlands
| | - Patrick J. Thoral
- Department of Intensive Care Medicine, Laboratory for Critical Care Computational Intelligence, Amsterdam Medical Data Science, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Paul W. G. Elbers
- Department of Intensive Care Medicine, Laboratory for Critical Care Computational Intelligence, Amsterdam Medical Data Science, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
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Fleuren LM, Dam TA, Tonutti M, de Bruin DP, Lalisang RCA, Gommers D, Cremer OL, Bosman RJ, Rigter S, Wils EJ, Frenzel T, Dongelmans DA, de Jong R, Peters M, Kamps MJA, Ramnarain D, Nowitzky R, Nooteboom FGCA, de Ruijter W, Urlings-Strop LC, Smit EGM, Mehagnoul-Schipper DJ, Dormans T, de Jager CPC, Hendriks SHA, Achterberg S, Oostdijk E, Reidinga AC, Festen-Spanjer B, Brunnekreef GB, Cornet AD, van den Tempel W, Boelens AD, Koetsier P, Lens J, Faber HJ, Karakus A, Entjes R, de Jong P, Rettig TCD, Arbous S, Vonk SJJ, Fornasa M, Machado T, Houwert T, Hovenkamp H, Noorduijn-Londono R, Quintarelli D, Scholtemeijer MG, de Beer AA, Cina G, Beudel M, Herter WE, Girbes ARJ, Hoogendoorn M, Thoral PJ, Elbers PWG. The Dutch Data Warehouse, a multicenter and full-admission electronic health records database for critically ill COVID-19 patients. Crit Care 2021; 25:304. [PMID: 34425864 PMCID: PMC8381710 DOI: 10.1186/s13054-021-03733-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 08/16/2021] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND The Coronavirus disease 2019 (COVID-19) pandemic has underlined the urgent need for reliable, multicenter, and full-admission intensive care data to advance our understanding of the course of the disease and investigate potential treatment strategies. In this study, we present the Dutch Data Warehouse (DDW), the first multicenter electronic health record (EHR) database with full-admission data from critically ill COVID-19 patients. METHODS A nation-wide data sharing collaboration was launched at the beginning of the pandemic in March 2020. All hospitals in the Netherlands were asked to participate and share pseudonymized EHR data from adult critically ill COVID-19 patients. Data included patient demographics, clinical observations, administered medication, laboratory determinations, and data from vital sign monitors and life support devices. Data sharing agreements were signed with participating hospitals before any data transfers took place. Data were extracted from the local EHRs with prespecified queries and combined into a staging dataset through an extract-transform-load (ETL) pipeline. In the consecutive processing pipeline, data were mapped to a common concept vocabulary and enriched with derived concepts. Data validation was a continuous process throughout the project. All participating hospitals have access to the DDW. Within legal and ethical boundaries, data are available to clinicians and researchers. RESULTS Out of the 81 intensive care units in the Netherlands, 66 participated in the collaboration, 47 have signed the data sharing agreement, and 35 have shared their data. Data from 25 hospitals have passed through the ETL and processing pipeline. Currently, 3464 patients are included in the DDW, both from wave 1 and wave 2 in the Netherlands. More than 200 million clinical data points are available. Overall ICU mortality was 24.4%. Respiratory and hemodynamic parameters were most frequently measured throughout a patient's stay. For each patient, all administered medication and their daily fluid balance were available. Missing data are reported for each descriptive. CONCLUSIONS In this study, we show that EHR data from critically ill COVID-19 patients may be lawfully collected and can be combined into a data warehouse. These initiatives are indispensable to advance medical data science in the field of intensive care medicine.
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Affiliation(s)
- Lucas M. Fleuren
- Laboratory for Critical Care Computational Intelligence, Department of Intensive Care Medicine, Amsterdam Medical Data Science, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Tariq A. Dam
- Laboratory for Critical Care Computational Intelligence, Department of Intensive Care Medicine, Amsterdam Medical Data Science, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | | | | | | | - Diederik Gommers
- Department of Intensive Care, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | | | - Sander Rigter
- Department of Anesthesiology and Intensive Care, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Evert-Jan Wils
- Department of Intensive Care, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
| | - Tim Frenzel
- Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Dave A. Dongelmans
- Department of Intensive Care Medicine, Amsterdam UMC, Amsterdam, The Netherlands
| | - Remko de Jong
- Intensive Care, Bovenij Ziekenhuis, Amsterdam, The Netherlands
| | - Marco Peters
- Intensive Care, Canisius Wilhelmina Ziekenhuis, Nijmegen, The Netherlands
| | | | | | - Ralph Nowitzky
- Intensive Care, HagaZiekenhuis, Den Haag, The Netherlands
| | | | - Wouter de Ruijter
- Department of Intensive Care Medicine, Northwest Clinics, Alkmaar, The Netherlands
| | | | - Ellen G. M. Smit
- Intensive Care, Spaarne Gasthuis, Haarlem en Hoofddorp, The Netherlands
| | | | - Tom Dormans
- Intensive Care, Zuyderland MC, Heerlen, The Netherlands
| | | | | | | | | | | | | | - Gert B. Brunnekreef
- Department of Intensive Care, Ziekenhuisgroep Twente, Almelo, The Netherlands
| | - Alexander D. Cornet
- Department of Intensive Care, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Walter van den Tempel
- Department of Intensive Care, Ikazia Ziekenhuis Rotterdam, Rotterdam, The Netherlands
| | - Age D. Boelens
- Anesthesiology, Antonius Ziekenhuis Sneek, Sneek, The Netherlands
| | - Peter Koetsier
- Intensive Care, Medisch Centrum Leeuwarden, Leeuwarden, The Netherlands
| | - Judith Lens
- ICU, ICU, IJsselland Ziekenhuis, Capelle aan den IJssel, The Netherlands
| | | | - A. Karakus
- Department of Intensive Care, Diakonessenhuis Hospital, Utrecht, The Netherlands
| | - Robert Entjes
- Department of Intensive Care, Admiraal De Ruyter Ziekenhuis, Goes, The Netherlands
| | - Paul de Jong
- Department of Anesthesia and Intensive Care, Slingeland Ziekenhuis, Doetinchem, The Netherlands
| | | | - Sesmu Arbous
- Department of Intensive Care, LUMC, Leiden, The Netherlands
| | | | | | | | | | | | | | | | | | | | | | - Martijn Beudel
- Department of Neurology, Amsterdam UMC, Universiteit van Amsterdam, Amsterdam, The Netherlands
| | | | - Armand R. J. Girbes
- Laboratory for Critical Care Computational Intelligence, Department of Intensive Care Medicine, Amsterdam Medical Data Science, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Mark Hoogendoorn
- Quantitative Data Analytics Group, Department of Computer Science, Faculty of Science, Vrjie Universiteit, Amsterdam, The Netherlands
| | - Patrick J. Thoral
- Laboratory for Critical Care Computational Intelligence, Department of Intensive Care Medicine, Amsterdam Medical Data Science, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Paul W. G. Elbers
- Laboratory for Critical Care Computational Intelligence, Department of Intensive Care Medicine, Amsterdam Medical Data Science, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
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8
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Bakker T, Abu-Hanna A, Dongelmans DA, Vermeijden WJ, Bosman RJ, de Lange DW, Klopotowska JE, de Keizer NF, Hendriks S, Ten Cate J, Schutte PF, van Balen D, Duyvendak M, Karakus A, Sigtermans M, Kuck EM, Hunfeld NGM, van der Sijs H, de Feiter PW, Wils EJ, Spronk PE, van Kan HJM, van der Steen MS, Purmer IM, Bosma BE, Kieft H, van Marum RJ, de Jonge E, Beishuizen A, Movig K, Mulder F, Franssen EJF, van den Bergh WM, Bult W, Hoeksema M, Wesselink E. Clinically relevant potential drug-drug interactions in intensive care patients: A large retrospective observational multicenter study. J Crit Care 2020; 62:124-130. [PMID: 33352505 DOI: 10.1016/j.jcrc.2020.11.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 11/16/2020] [Accepted: 11/27/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE Potential drug-drug interactions (pDDIs) may harm patients admitted to the Intensive Care Unit (ICU). Due to the patient's critical condition and continuous monitoring on the ICU, not all pDDIs are clinically relevant. Clinical decision support systems (CDSSs) warning for irrelevant pDDIs could result in alert fatigue and overlooking important signals. Therefore, our aim was to describe the frequency of clinically relevant pDDIs (crpDDIs) to enable tailoring of CDSSs to the ICU setting. MATERIALS & METHODS In this multicenter retrospective observational study, we used medication administration data to identify pDDIs in ICU admissions from 13 ICUs. Clinical relevance was based on a Delphi study in which intensivists and hospital pharmacists assessed the clinical relevance of pDDIs for the ICU setting. RESULTS The mean number of pDDIs per 1000 medication administrations was 70.1, dropping to 31.0 when considering only crpDDIs. Of 103,871 ICU patients, 38% was exposed to a crpDDI. The most frequently occurring crpDDIs involve QT-prolonging agents, digoxin, or NSAIDs. CONCLUSIONS Considering clinical relevance of pDDIs in the ICU setting is important, as only half of the detected pDDIs were crpDDIs. Therefore, tailoring CDSSs to the ICU may reduce alert fatigue and improve medication safety in ICU patients.
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Affiliation(s)
- Tinka Bakker
- Amsterdam UMC (location AMC), Department of Medical Informatics, Meibergdreef 9, 1105, AZ, Amsterdam, the Netherlands.
| | - Ameen Abu-Hanna
- Amsterdam UMC (location AMC), Department of Medical Informatics, Meibergdreef 9, 1105, AZ, Amsterdam, the Netherlands.
| | - Dave A Dongelmans
- Amsterdam UMC (location AMC), Department of Intensive Care Medicine, Meibergdreef 9, 1105, AZ, Amsterdam, the Netherlands.
| | - Wytze J Vermeijden
- Department of Intensive Care, Medisch Spectrum Twente, Koningsplein 1, 7512, KZ, Enschede, the Netherlands.
| | - Rob J Bosman
- Department of Intensive Care, Onze Lieve Vrouwe Gasthuis, Oosterpark 9, 1091, AC, Amsterdam, the Netherlands.
| | - Dylan W de Lange
- Department of Intensive Care and Dutch Poison Information Center, University Medical Center Utrecht, University Utrecht, Heidelberglaan 100, 3584, CX, Utrecht, the Netherlands.
| | - Joanna E Klopotowska
- Amsterdam UMC (location AMC), Department of Medical Informatics, Meibergdreef 9, 1105, AZ, Amsterdam, the Netherlands.
| | - Nicolette F de Keizer
- Amsterdam UMC (location AMC), Department of Medical Informatics, Meibergdreef 9, 1105, AZ, Amsterdam, the Netherlands.
| | | | - S Hendriks
- Department of Intensive Care, Albert Schweitzer Ziekenhuis, Dordrecht, The Netherlands
| | - J Ten Cate
- Department of Intensive Care, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - P F Schutte
- Department of Intensive Care, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - D van Balen
- Department of Pharmacy & Pharmacology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - M Duyvendak
- Department of Hospital Pharmacy, Antonius Hospital, Sneek, The Netherlands
| | - A Karakus
- Department of Intensive Care Diakonessenhuis Utrecht, Utrecht, The Netherlands
| | - M Sigtermans
- Department of Intensive Care Diakonessenhuis Utrecht, Utrecht, The Netherlands
| | - E M Kuck
- Department of Hospital Pharmacy, Diakonessenhuis Utrecht, Utrecht, The Netherlands
| | - N G M Hunfeld
- Department of Intensive Care, Erasmus MC, Rotterdam, The Netherlands; Department of Hospital Pharmacy, ErasmusMC, Rotterdam, The Netherlands
| | - H van der Sijs
- Department of Hospital Pharmacy, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - P W de Feiter
- Department of Intensive Care, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
| | - E-J Wils
- Department of Intensive Care, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
| | - P E Spronk
- Department of Intensive Care Medicine, Gelre Hospitals, Apeldoorn, The Netherlands
| | - H J M van Kan
- Department of Clinical Pharmacy, Gelre Hospitals, Apeldoorn, The Netherlands
| | - M S van der Steen
- Department of Intensive Care, Ziekenhuis Gelderse Vallei, Ede, The Netherlands
| | - I M Purmer
- Department of Intensive Care, Haga Hospital, The Hague, The Netherlands
| | - B E Bosma
- Department of Hospital Pharmacy, Haga Hospital, The Hague, The Netherlands
| | - H Kieft
- Department of Intensive Care, Isala Hospital, Zwolle, The Netherlands
| | - R J van Marum
- Department of Clinical Pharmacology, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands; Amsterdam UMC (location VUmc), Department of Elderly Care Medicine, Amsterdam, The Netherlands
| | - E de Jonge
- Department of Intensive Care, Leiden University Medical Center, Leiden, The Netherlands
| | - A Beishuizen
- Department of Intensive Care, Medisch Spectrum Twente, Enschede, The Netherlands
| | - K Movig
- Department of Clinical Pharmacy, Medisch Spectrum Twente, Enschede, The Netherlands
| | - F Mulder
- Department of Pharmacology, Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands
| | - E J F Franssen
- OLVG Hospital, Department of Clinical Pharmacy, Amsterdam, The Netherlands
| | - W M van den Bergh
- Department of Critical Care, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - W Bult
- Department of Critical Care, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - M Hoeksema
- Zaans Medisch Centrum, Department of Anesthesiology, Intensive Care and Painmanagement, Zaandam, The Netherlands
| | - E Wesselink
- Department of Clinical Pharmacy, Zaans Medisch Centrum, Zaandam, The Netherlands
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Yurt M, Ayyildiz O, Karakus A, Nursal AF, Isi H. MicroRNAs expression profiles as biomarkers and therapeutic tools in Turkish patients with chronic myeloid leukemia. Bratisl Lek Listy 2020; 121:159-163. [PMID: 32115971 DOI: 10.4149/bll_2020_023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
AIM In 95 % of Chronic myeloid leukemia (CML) patients, chromosomal translocation resulting in the formation of the Philadelphia (Ph) chromosome (t:9;22) is observed, which in turn leads to the formation of the BCR-ABL fusion gene. MicroRNAs (miRNAs) are a group of small and non-coding RNAs modulating gene expression via binding to the target mRNAs. We aimed to characterize the expression profiles of various miRNAs in different stages of Ph(+) CML patients. METHODS This case-controlled study was conducted in 75 CML patients and 25 healthy controls. The subjects were categorized into 4 groups; newly diagnosed patients, treatment-response patients, treatment-failure patients, and healthy controls. Expressions of miRNAs was analyzed by RT-PCR. RESULTS miR-150 expression was downregulated in the treatment failure patients compared to the control group (p = 0.003212) while miRNA 148b expression up-regulated in the treatment failure patients than the control group (p = 0.038016). miR-10a expression was up-regulated in newly diagnosed and treatment response patients compared to control group (p = 0.003934, p = 0.000292, respectively). It was found that miR-10a expression increased 11.17- fold in newly diagnosed patients and 9.82-fold in treatment response patients than in the control group. CONCLUSION Our data suggest that expression profiles of miR-10a, miR-150, and miRNA 148b were correlated as biomarker and therapeutic tool in Turkish patients with CML (Tab. 2, Fig. 1, Ref. 30).
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Kuvandik G, Ucar E, Karakus A. Epidemiology and cost of burns in emergency department during Syrian civil war. BRATISL MED J 2019; 119:731-735. [PMID: 30686008 DOI: 10.4149/bll_2018_131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND We aimed to emphasize the importance of regional hospitals' capacities and emergency services for burn patients in war and disaster situations, in addition to assessing the costs and clinical situations of seriously burned patients who have come to the emergency service due to the bomb and heater burst during the Syrian civil war. METHODS In this study, we analyzed these 217 burn patients and analyzed these patients' data for retrospective analysis. RESULTS Burn patients were more often seen during the winter months. The majority of the patients were children, young adults and male (1‒16 age, 95 % burn, 44 %,17‒40 age 94 % burn, 44 %, ≥ 41‒65 age, 28 % burn, 12 %). The most common body surface burns ≥ 20 % body surface in surviving patients n = 184, 78 % were determined. 14 of the burned patients died within the first 24 hours. The total cost of the burned patients in the emergency unit was observed to be 33.4 ± 25.9 Turkish Lira (10.2‒6813.2). CONCLUSION The present study showed that burn patients need much longer treatment time. The need for trained personnel in case of mass disasters and warfare, the identification of burn intensive care units and hospitals to be referred is important (Tab. 2, Fig. 4, Ref. 23).
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11
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Karakus A, Kuvandik G, Atalay E. Evaluation of Extremity Injuries Presented to Emergency Department. Arch Iran Med 2017; 20:646-648. [PMID: 29137466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVE In this study, we aimed to review cases with firearms injury of extremities presented to our hospital. METHODS After approval by Institutional Board, electronic database was retrospectively screened for firearms injury of extremities between 2012 and 2015. Overall, 600 cases with firearms injury of extremities were included in the study. Cases were assessed for demographic and clinical characteristics, Mangled extremity severity score (MESS), Glasgow Coma Scale (GCS), costs and outcomes. RESULTS Totally, 552 (92.0%) cases were men and 48 (8.0%) were women. Mean age was 29.97 ± 10.40 years (range: 5-64 years). A significant difference was detected in gender distribution. Of the cases, 96.6% (n = 580) were Syrian war casualties. Lower extremity injury was the most frequently seen injury (n = 312; 52.0%). Mean MESS score was 4.71 ± 1.32 (range: 2-9). GCS score was <8 in 3 fatal cases (0.5%) whereas it was 15 in 597 cases (99.5%). It was found that 66 cases (11.0%) underwent amputation after they arrived in the hospital as a result of crush injury due to mine and blast. In cases who underwent amputation, a positive correlation was detected in MESS scores (P = 0.00). Mean cost was estimated to be 6,936 TL (280-32,232 TL). CONCLUSION Young male and lower extremity injuries were most commonly encountered. Amputation was performed in the early period in cases with highest MESS scores. It was seen that amputation was common in crush injuries due to mine and blast. It was found that patient volume at emergency department and hospital and costs were increased due to war.
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Affiliation(s)
- Ali Karakus
- Mustafa Kemal University, Faculty of Medicine, Emergency Medicine, Hatay, Turkey
| | - Guven Kuvandik
- Mustafa Kemal University, Faculty of Medicine, Emergency Medicine, Hatay, Turkey
| | - Ezgi Atalay
- Mustafa Kemal University, Hatay Health Services, Vocational School, First and Emergency Assistance Program, Hatay, Turkey
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12
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Yanikkerem E, Goker A, Ustgorul S, Karakus A. Evaluation of sexual functions and marital adjustment of pregnant women in Turkey. Int J Impot Res 2016; 28:176-83. [PMID: 27305839 DOI: 10.1038/ijir.2016.26] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 03/22/2016] [Accepted: 05/08/2016] [Indexed: 11/09/2022]
Abstract
The aim of this study was to evaluate pregnant women's sexual function and marital adjustment. The sample of the study included 298 women, and it was evaluated using Golombok Rust Inventory of Sexual Satisfaction (GRISS) Scale and Marital Adjustment Scale. The most important reasons for decreasing the frequency of sexual intercourse included the fear of harming the fetus during intercourse (62.1%), fear of having miscarriage (47.8%) and decreased sexual desire (34.7%). It was found that women with sexual dysfunction had a significantly lower educational level, were living with three or more people in their home, were multiparious, had an unplanned pregnancy, reported pain during sexual intercourse and felt that their sexual life was very affected during pregnancy. The findings of the study showed that women had ⩾5 points for GRISS for the subscales as follows: infrequency (47.3%), non-communication (57.4%), dissatisfaction (15.4%), avoidance (6.4%), non-sensuality (19.1%), vaginismus (28.9%), anorgasmia (29.9%) and sexual dysfunction (17.4%). In conclusion, women who were living with three or more people at home, had lower income level, were smoking and had an unplanned pregnancy scored under 43.5 of MAS. It was found negative and there was a medium correlation between MAS score and total GRISS score.
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Affiliation(s)
- E Yanikkerem
- Celal Bayar University, School of Health, İstasyon mevki, Manisa, Turkey
| | - A Goker
- Department of Obstetrics and Gynecology, Celal Bayar University, Celal Bayar University Hafsa Sultan Hospital, Manisa, Turkey
| | - S Ustgorul
- Celal Bayar University, School of Health, İstasyon mevki, Manisa, Turkey
| | - A Karakus
- Celal Bayar University, School of Health, İstasyon mevki, Manisa, Turkey
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Alp H, Pinar N, Dokuyucu R, Kaplan I, Sahan M, Senol S, Karakus A, Yaldiz M. Effects of intralipid and caffeic acid phenyl esther (CAPE) against hepatotoxicity and nephrotoxicity caused by glyphosate isopropylamine (GI). EUR J INFLAMM 2016. [DOI: 10.1177/1721727x16630318] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This study was aimed to investigate the protective effects of caffeic acid phenyl esther (CAPE) and Intralipid (IL) against hepatotoxicity and nephrotoxicity caused by acute intoxication of glyphosate (N-phosphonomethyl)glycine) (GI) in rats. Forty-nine Wistar Albino rats were randomly divided into seven groups as: I, Control; II, Intralipid (IL) (18.6 mL/kg, orally); III, CAPE (10 µmol/kg, intraperitoneally); IV, GI (4 mg/kg/day, intraperitoneally); V, GI + IL; VI, GI+CAPE; and VII, GI + IL + CAPE. Total antioxidant status (TAS) and total oxidant status (TOS) levels were measured in serum samples. Tissues were analyzed with hematoxylin and eosin (H&E) staining protocol. Bcl-2, Bax, and caspase-3 were evaluated by immunohistochemical method. The results revealed that, in hepatic tissues, the TAS levels were lower and the TOS levels were higher in the GI group compared to other groups. In renal tissues, the TAS levels were significantly lower in the GI group than in the control, IL, CAPE, and GI + IL + CAPE groups. The TOS levels were significantly higher in the GI group than in the control group. Moreover, histopathological analysis revealed severe hepatotoxicity in the GI group. In the GI + CAPE + IL group, hepatotoxicity recovered significantly. Nephrotoxicity was also observed in the GI group and moderately reduced in the GI + CAPE group. Biochemical results were confirmed by histopathologic examination. The results also revealed that CAPE and IL, due to their antioxidant effects, have a decreasing effect against both hepatotoxicity and nephrotoxicity caused by GI. Therefore, CAPE and IL may function as potential agents for supportive therapy since they decrease organ damage, or may facilitate the therapeutic effects of the routine treatment of patients with GI poisoning.
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Affiliation(s)
- Harun Alp
- Department of Pharmacology, School of Medicine, Mustafa Kemal University, Hatay, Turkey
| | - Neslihan Pinar
- Department of Pharmacology, School of Medicine, Mustafa Kemal University, Hatay, Turkey
| | - Recep Dokuyucu
- Department of Medical Physiology, School of Medicine, Mustafa Kemal University, Hatay, Turkey
| | - Ibrahim Kaplan
- Department of Medical Biochemistry, School of Medicine, Dicle University, Diyarbakir, Turkey
| | - Mustafa Sahan
- Department of Emergency Medicine, School of Medicine, Mustafa Kemal University, Hatay, Turkey
| | - Serkan Senol
- Department of Medical Pathology, School of Medicine, Medeniyet University Istanbul, Turkey
| | - Ali Karakus
- Department of Emergency Medicine, School of Medicine, Mustafa Kemal University, Hatay, Turkey
| | - Mehmet Yaldiz
- Department of Medical Pathology, School of Medicine, Mustafa Kemal University, Hatay, Turkey
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14
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Dal MS, Karakus A, Aydin BB, Ekmen MO, Ulas T, Ayyildiz O. Serum uric acid and inflammation in patients with immune thrombocytopenic purpura: preliminary results. Eur Rev Med Pharmacol Sci 2015; 19:4385-4389. [PMID: 26636527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE The purpose of this study was to evaluate the uric acid (UA) and C-reactive protein (CRP) levels in patients with immune thrombocytopenic purpura (ITP). PATIENTS AND METHODS Forty patients with newly diagnosed ITP and 40 healthy individuals were enrolled in the study. The patients were divided into two groups; group 1 (n = 40) consisted of patients with ITP, and group 2 (n = 40) consisted of healthy subjects. UA and CRP levels were measured in the blood samples from them. RESULTS There were no statistical differences in gender, age and body mass index between two groups (p > 0.05 for all). Compared to group 2, group 1 had significantly higher UA levels (p = 0.002), whereas CRP levels were not significantly different (p > 0.05). In ITP patients, serum UA and CRP levels significantly correlated with low platelet count (r = -0.362, p = 0.022; r = -0.383, p = 0.015, respectively); and UA levels significantly correlated with CRP levels (r = 0.436, p = 0.005). CONCLUSIONS The present study showed that UA levels increased in patients with ITP and negatively correlated with platelet counts. UA levels might be a mediator of inflammation via enhanced production of inflammatory cytokines; they might also be a potential mediator of low platelet count, and could play a pathophysiological role in the development of ITP.
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Affiliation(s)
- M S Dal
- Department of Hematology, Dicle University, Faculty of Medicine, Diyarbakir, Turkey.
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15
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Basarslan K, Basarslan F, Karakus A, Yilmaz C. Isolated brain stem edema in a pediatric patient with head trauma: a case report. Eur Rev Med Pharmacol Sci 2015; 19:998-1000. [PMID: 25855924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Brain stem is the most vital part of our body and is a transitional region of the brain that connects the cerebrum with the spinal cord. Though, being small in size, it is full of indispensible functions such as the breathing, heart beat. Injury to the brain stem has similar effects as a brain injury, but it is more fatal. Use of the Glasgow Coma Score as a prognostic indicator of outcome in patients with head injuries is widely accepted in clinical practice. Traumatic brain stem edema in children is rare, but is associated with poor outcome. The question is that whether it is being aware of computerized tomography appearance of the posterior fossa when initial evaluating pediatric patients with head trauma at emergency clinics. Normal and edematous brain stem without an additional pathology are slightly different and not distinguished easily. On the other hand, brain stem edema should be promptly identified and appropriately treated in a short time.
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Affiliation(s)
- K Basarslan
- Department of Neurosurgery, Department of Pediatrics, Department of Emergency Medicine, Department of Pediatric Neurology; Faculty of Medicine, Mustafa Kemal University, Hatay, Turkey.
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16
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Karakus A, Ozkan M, Karcioglu M, Ozden R, Ustun I, Caliskan K, Gokce C, Sahan M. Diabetic foot due to anaphylactic shock: a case report. Arch Trauma Res 2014; 3:e17610. [PMID: 25147776 PMCID: PMC4139693 DOI: 10.5812/atr.17610] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Revised: 04/08/2014] [Accepted: 05/24/2014] [Indexed: 11/16/2022]
Abstract
Introduction: Diabetic foot is a clinical disorder, which is commonly seen in patients with diabetes mellitus. It is also the major cause of below knee amputation in the world. There are many underlying causes such as neuropathic, ischemic, and infectious causes for diabetic foot. Local or systemic complications may develop after snake bite. Case Presentation: We reported a very rare case, involving a 78-year-old male admitted to the Emergency Department, who developed anaphylactic shock and diabetic foot after the snake bite. Conclusions: Reviewing the literature, this is the second reported case of snake bite associated with diabetic foot.
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Affiliation(s)
- Ali Karakus
- Department of Emergency Medicine, Faculty of Medicine, Mustafa Kemal University, Hatay, Turkey
- Corresponding author: Ali Karakus, Department of Emergency Medicine, Faculty of Medicine, Mustafa Kemal University, Hatay, Turkey. Tel: +90-5052540433, Fax: +90-3262455654, E-mail:
| | - Mustafa Ozkan
- Department of Plastic Surgery, Faculty of Medicine, Mustafa Kemal University, Hatay, Turkey
| | - Murat Karcioglu
- Department of Anesthesia, Faculty of Medicine, Mustafa Kemal University, Hatay, Turkey
| | - Raif Ozden
- Department of Orthopedic Surgery, Faculty of Medicine, Mustafa Kemal University, Hatay, Turkey
| | - Ihsan Ustun
- Department of Endocrinology, Faculty of Medicine, Mustafa Kemal University, Hatay, Turkey
| | - Koca Caliskan
- Department of Emergency Medicine, Faculty of Medicine, Mustafa Kemal University, Hatay, Turkey
| | - Cumali Gokce
- Department of Endocrinology, Faculty of Medicine, Mustafa Kemal University, Hatay, Turkey
| | - Mustafa Sahan
- Department of Emergency Medicine, Faculty of Medicine, Mustafa Kemal University, Hatay, Turkey
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17
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Yontar OC, Tutuncu A, Karaagac K, Karakus A, Yontar ONUR, Melek M. P636T wave peak to t wave end interval is prolonged in patients with atrioventricular nodal reentry:. Cardiovasc Res 2014. [DOI: 10.1093/cvr/cvu098.63] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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18
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Karakus A, Cengiz B, Zinnuroglu M. P844: H-reflex recovery cycle as an electrophysiological correlate of spasticity. Clin Neurophysiol 2014. [DOI: 10.1016/s1388-2457(14)50874-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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19
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Oei A, Kok M, Karakus A, Endeman H. Tissue oxygenation in patients with severe sepsis. Crit Care 2014. [PMCID: PMC4068230 DOI: 10.1186/cc13430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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20
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Tuzcu K, Alp H, Ozgur T, Karcioglu M, Davarci I, Evliyaoglu O, Karakus A, Hakimoglu S. Oral intralipid emulsion use: a novel therapeutic approach to pancreatic β-cell injury caused by malathion toxicity in rats. Drug Chem Toxicol 2013; 37:261-7. [DOI: 10.3109/01480545.2013.838780] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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21
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Ari H, Emlek N, Cosar S, Aydin C, Doganay K, Karakus A, Zengin I, Bozat T, Melek M. The effect of high dose Cilostazol and Rosuvastatin on myocardial damage in patients with elective percutaneous coronary intervention (PREVENT trial). Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht307.p680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Sahan M, Yılmaz M, Gokel Y, Erden ES, Karakus A. Nebulized salbutamol for asthma: effects on serum potassium and phosphate levels at the 60 min. Rev Port Pneumol 2013; 19:200-3. [PMID: 23659992 DOI: 10.1016/j.rppneu.2012.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2012] [Revised: 12/01/2012] [Accepted: 12/17/2012] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVE We conducted this prospective study to expand available information in relation to serum phosphate levels in treatment of acute asthma. A β-adrenergic agonist, salbutamol, was used for this purpose. MATERIAL AND METHODS Twenty-six patients who met the inclusion criteria as; age over 16 years, asthma history, and an acute exacerbation were included. Serum blood urea nitrogen, creatinine, glucose were within normal limits in all the patients. None of the patients were on chronic theophylline therapy. Baseline serum phosphate and potassium levels were measured. Nebulized salbutamol (2.5mg) was used three times at every hour. After 60 min, serum phosphate and potassium levels were measured. RESULTS Serum phosphate levels decreased from 3.7±0.9 mg/dL (baseline) to 3.6±0.9 mg/dL at 60 min. This decrease was not statistically significant (p=0.373). Serum potassium levels decreased significantly (p<0.001) from 4.6±0.7 mmol/L (baseline) to 4.3±0.7 mmol/L (60 min). CONCLUSION Administration of nebulized salbutamol during the emergency treatment of acute exacerbation of asthma is not associated with a statistical decrease in serum phosphate. There was significant hypokalemia. This study indicates that a further study is needed to elucidate the clinical significance of nebulized salbutamol on serum phosphate.
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Affiliation(s)
- M Sahan
- Department of Emergency Medicine, Elazig Training & Education Hospital, Elazig, Turkey
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24
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Abstract
Abstract
Three-dimensional (3-D) computational modeling approach of mold insert injection molding is developed to build a more robust and complete simulation solution of polymer melt flow in a mold cavity considering the effects of process conditions on non-isothermal, viscous, compressible and non-Newtonian flow behavior. The changes in viscosity and density in the polymer melt flow are successfully modeled within a volume of fluid (VOF) method coupled with a finite volume approach to generate more realistic melt flow physics during filling stage of injection molding under different process conditions. The Pressure Implicit with Splitting Operators (PISO) pressure-velocity coupling algorithm is employed to enable higher degree of approximate relation between corrections for pressure and velocity, and a comprehensive high-resolution differencing scheme (CICSAM) is successfully utilized to capture moving interfaces. The present developed numerical approach is verified for a box shape mold insert injection molding process of melt flow polypropylene (PP) and comparisons are made with a well-known commercial software program and the experimental data available in the open literature in terms of basic flow features. The numerical results are also compared with each other for each process condition to predict the evolution of a few flow parameters such as temperature and pressure field distributions in the selected regions of the mold cavity to optimize the polymer melt flow during the filling stage of injection molding. The present study is later extended to simulate the filling process of the injection molding for a mold insert PP pipe fitting model for further assessment of the modeling capabilities of the present numerical modeling methodology in injection molding of complex geometrical configurations.
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Affiliation(s)
- M. Tutar
- Department of Mechanical Engineering, Mersin University, Çiftlikköy-Mersin, Turkey
| | - A. Karakus
- Department of Mechanical Engineering, Mersin University, Çiftlikköy-Mersin, Turkey
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Karakus A, Zeren C, Celik MM, Arica S, Ozden R, Duru M, Tasın V. A 5-year retrospective evaluation of snakebite cases in Hatay, Turkey. Toxicol Ind Health 2013; 31:188-92. [PMID: 23299192 DOI: 10.1177/0748233712472522] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Snakebites are relatively rare medical emergency cases that might lead to serious consequences. This study aims to evaluate snakebite cases in terms of medical follow-up, antivenom therapy and antivenom reactions. Medical records of patients admitted to emergency department between January 1, 2006 and December 31, 2010 were retrospectively investigated. Snakebite-related cases of a total of 125 patients were included in the scope of the study. Of the total 125 cases, 54.4% were male and 45.6% were female. Most of cases ( n: 65, 52%) were aged over 30 years, while the mean age was 34.87 ± 19.29 years. Snakebite-related applications to the emergency department were mostly seen in June with 27 cases. Upon admitting, all patients were recorded to be conscious and showing good general conditions; however, they suffered from pain and edema at the site of bite. Of all, 25 patients only suffered from bite injury and ecchymosis due to snakebite. The site of bite was upper extremities in 66 patients (52.8%), whereas it was lower extremities in 58 (46.4%). Of all, antivenom was unnecessary in 25 (20%) patients, while four antivenoms were administered to each of the 23 (18.4%) patients. Furthermore, six (4.8%) patients needed nine antivenom administrations for each. Anaphylaxis ( n: 2, 1.6%), compartment syndrome ( n: 2, 1.6%) and serum sickness ( n: 1, 0.8%) encountered in remaining cases. Of all, 86 (68.8%) patients were hospitalized in the emergency department, while 25 (20.0%) patients were followed up by observation in emergency service. Only one patient was treated and followed up in intensive care unit. Implementation of antivenom therapy is considered unnecessary for the treatment of all snakebite cases. Antivenom reactions and number of related cases might be reduced by continuous close monitoring, appropriate prophylaxis and controlled slow infusion administration of medications.
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Affiliation(s)
- Ali Karakus
- Department of Emergency Medicine, Faculty of Medicine, Mustafa Kemal University, Hatay, Turkey
| | - Cem Zeren
- Department of Forensic Medicine, Faculty of Medicine, Mustafa Kemal University, Hatay, Turkey
| | - M Murat Celik
- Department of Internal Medicine, Faculty of Medicine, Mustafa Kemal University, Hatay, Turkey
| | - Secil Arica
- Department of Family Medicine, Faculty of Medicine, Mustafa Kemal University, Hatay, Turkey
| | - Raif Ozden
- Department of Orthopedic Medicine, Faculty of Medicine, Mustafa Kemal University, Hatay, Turkey
| | - Mehmet Duru
- Department of Emergency Medicine, Faculty of Medicine, Mustafa Kemal University, Hatay, Turkey
| | - Veyis Tasın
- Department of Emergency Medicine, Faculty of Medicine, Mustafa Kemal University, Hatay, Turkey
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26
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Karakus A, Yengil E, Akkucuk S, Cevik C, Zeren C, Uruc V. The reflection of the Syrian civil war to emergency department and assessment of hospital costs. ULUS TRAVMA ACIL CER 2013; 19:429-33. [DOI: 10.5505/tjtes.2013.78910] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Karakus A, Arslan G, Sahan M, Duru M. Turk J Emerg Med 2013; 13:55-56. [DOI: 10.5505/1304.7361.2013.82621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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29
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Saritas A, Kandis H, Baltaci D, Yildirim U, Kaya H, Karakus A, Colakoglu S, Memisogullari R, Kara IH. N-Acetyl cysteine and erdosteine treatment in acetaminophen-induced liver damage. Toxicol Ind Health 2012; 30:670-8. [PMID: 23070635 DOI: 10.1177/0748233712463780] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE This study is aimed to investigate the efficacy of erdosteine usage in acetaminophen-induced liver damage and to compare it with N-acetyl cysteine (NAC) in the treatment and prevention of liver toxicity due to overdose of acetaminophen. METHODS The rats were separated into the following six groups of seven rats each: control group; acetaminophen (1 g/kg, orally); acetaminophen (1 g/kg, orally) + erdosteine (150 mg/kg/day, orally); acetaminophen (1 g/kg, orally) + NAC (140 mg/kg loading dose, followed by 70 mg/kg, orally); NAC (140 mg/kg loading dose, followed by 70 mg/kg, orally); erdosteine (150 mg/kg/kg, orally), subsequently. In all the groups, potential liver injuries were evaluated using biochemical and hematological analyses, oxidant-antioxidant parameters and histopathological parameters. RESULTS In acetaminophen-treated group, levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), total oxidant status (TOS) in the blood, prothrombin time (PT) and international normalized ratio (INR) were significantly increased when compared with controls. However, total antioxidant capacity (TAC) and glutathione (GSH) levels were decreased in group treated with acetaminophen, when compared with control group. Levels of AST, ALT and TOS, PT and INR were decreased in groups treated with NAC and erdosteine after acetaminophen administration, but the levels of TAC and GSH were increased. Histopathological improvements were observed in the groups treated with NAC and erdosteine after acetaminophen administration. CONCLUSION The present study demonstrated that, in the prevention of liver damage induced by acetaminophen intoxication, an early treatment with a single dose of erdosteine was beneficial instead of NAC administration.
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Affiliation(s)
- Ayhan Saritas
- Department of Emergency Medicine, Duzce University School of Medicine, Duzce, Turkey
| | - Hayati Kandis
- Department of Emergency Medicine, Duzce University School of Medicine, Duzce, Turkey
| | - Davut Baltaci
- Department of Family Medicine, Duzce University School of Medicine, Duzce, Turkey
| | - Umran Yildirim
- Department of Pathology, Duzce University School of Medicine, Duzce, Turkey
| | - Halil Kaya
- Department of Emergency Medicine, Harran University School of Medicine, Sanliurfa, Turkey
| | - Ali Karakus
- Department of Emergency Medicine, Mustafa Kemal University School of Medicine, Hatay, Turkey
| | - Serdar Colakoglu
- Department of Anatomy, Duzce University School of Medicine, Duzce, Turkey
| | | | - Ismail Hamdi Kara
- Department of Family Medicine, Duzce University School of Medicine, Duzce, Turkey
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Inal A, Kucukoner M, Kaplan MA, Urakci Z, Karakus A, Komek H, Dostbil Z, Isikdogan A. Prognostic value of fluorine-18 fluorodeoxyglucose positron emission tomography in patients with advanced non-small cell lung cancer: single center experience. J BUON 2012; 17:724-728. [PMID: 23335532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
PURPOSE The purpose of this retrospective single-center study was to evaluate the prognostic implication on overall survival (OS) of the F-18 FDG PET scan in locally advanced or metastatic non small cell lung cancer (NSCLC) patients. METHODS We retrospectively reviewed 120 locally advanced or metastatic NSCLC patients (December 2004-November 2011) treated/followed at the Dicle University, School of Medicine, Department of Medical Oncology. SUVmax and other potential prognostic variables (n=18) were chosen for analysis. Univariate and multivariate analyses were conducted to identify prognostic factors for OS. RESULTS Among 18 variables of univariate analysis, 6 were identified to bear prognostic significance: sex (p=0.01), performance status (PS) (p =0.03), stage (p=0.04), bone metastases (p=0.002), serum albumin (p=0.01) and blood glucose level (p=0.03). Multivariate analysis showed that PS, bone metastases and serum albumin level were independent prognostic factors for OS (p=0.01, p=0.004, p=0.003, respectively). CONCLUSION PS, serum albumin levels and bone metastases were independent prognostic factors, while FDG uptake of the primary lesion was not associated with prognosis of OS in locally advanced or metastatic NSCLC patients.
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Affiliation(s)
- A Inal
- Department of Medical Oncology, Dicle University, Diyarbakir, Turkey.
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Karakus A, Celik MM, Karcioglu M, Tuzcu K, Erden ES, Zeren C. Cases of organophosphate poisoning treated with high-dose of atropine in an intensive care unit and the novel treatment approaches. Toxicol Ind Health 2012; 30:421-5. [PMID: 23012340 DOI: 10.1177/0748233712462478] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Organophosphate poisoning is a life-threatening condition, which is being responsible for the symptoms due to cholinergic effects. Clinical status and blood levels of cholinesterase are used its diagnosis. While atropine and pralidoxime (PAM) appear as essential medications, hemofiltration treatments and lipid solutions have been widely studied in recent years. In this study, the importance of high-dose atropine therapy and early intervention and novel treatment approaches are discussed. Records of a total of 25 patients treated for organophosphate poisoning in the intensive care unit (ICU) between April 2007 and December 2011 were evaluated retrospectively. Of the 25 patients, 14 (56%) were male and 11 (44%) were female with a mean age of 34.8 ± 17.66 years (range: 14-77 years). The patients were most frequently admitted in June (n = 4) and July (n = 4) (16%). Of the 25 patients, 22 patients (88%) were poisoned by oral intake, two (8%) by inhalation, and one (4%) by dermal route. Of them, 20 patients (80%) took organophosphates intentionally for suicidal purposes, while five (20%) cases poisoned due to accidental exposure. The scores of Glasgow Coma Scale of nine patients (36%) were below 8 point upon admission to hospital. The highest dose of atropine given was 100 mg intravenously on admission and 100 mg/h/day during follow-up. The total dose given was 11.6 g/12 days. A total of 11 patients (44%) were on mechanical ventilation for a mean duration of 5.73 ± 4.83 days. The mean duration of ICU stay was 6.52 ± 4.80 days. Of all, 23 patients (92%) were discharged in good clinical condition and one patient (4%) was referred to another hospital. This study suggests that atropine can be administered until secretions disappear and intensive care should be exerted in follow-up of these patients. In addition, in case of necessity for high doses, sufficient amounts of atropine and PAM should be available in hospitals.
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Affiliation(s)
- Ali Karakus
- Department of Emergency Medicine, Faculty of Medicine, Mustafa Kemal University, Hatay, Turkey
| | - Muhammet Murat Celik
- Department of Internal Medicine, Faculty of Medicine Mustafa Kemal University, Hatay, Turkey
| | - Murat Karcioglu
- Department of Anesthesia, Faculty of Medicine, Mustafa Kemal University, Hatay, Turkey
| | - Kasim Tuzcu
- Department of Anesthesia, Faculty of Medicine, Mustafa Kemal University, Hatay, Turkey
| | - Ersin Sukru Erden
- Department of Chest Diseases, Faculty of Medicine, Mustafa Kemal University, Hatay, Turkey
| | - Cem Zeren
- Department of Forensic Medicine, Faculty of Medicine, Mustafa Kemal University, Hatay, Turkey
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Inal A, Kaplan MA, Kucukoner M, Karakus A, Isikdogan A. Prognostic factors in elderly patients with advanced non-small cell lung cancer treated with first-line cisplatin-based chemotherapy: a retrospective analysis of single institution. J BUON 2012; 17:533-536. [PMID: 23033295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
PURPOSE Non-small cell lung cancer (NSCLC) makes up 80-85% of all lung cancers cases. Lung cancer in older individuals is frequently undertreated. Patients eligible for cisplatin- based chemotherapy should be selected carefully. The aim of this retrospective single-center study was to evaluate prognostic factors for overall survival (OS) in elderly (≥65 years) patients with advanced NSCLC who received first-line cisplatin-based chemotherapy. METHODS We retrospectively reviewed 110 elderly patients with locally advanced or metastatic NSCLC who had been administered cisplatin-based first-line chemotherapy between December 2004 and November 2011. Seventeen potential prognostic variables were chosen for analysis. Univariate and multivariate analyses were conducted to identify prognostic factors associated with OS. RESULTS Among the 17 variables of univariate analysis, 4 were identified to have prognostic significance for OS: comorbidities (p<0.001), Eastern Cooperative Oncology Group (ECOG) performance status (PS) (p=0.02), first-line chemotherapy cycles (p<0.001) and serum albumin level (p=0.04). Multivariate analysis showed that only ECOG PS (p=0.01) was independent prognostic factor for OS. CONCLUSION PS was important prognostic factor in elderly patients with advanced NSCLC. The findings of this study may facilitate pretreatment prediction of OS and therefore can be used for selecting the most appropriate treatment for elderly patients.
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Affiliation(s)
- A Inal
- Department of Medical Oncology, Dicle University, Diyarbakir, Turkey.
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Abstract
Licorice originates from the root of Glycyrrhiza glabra, which has a herbal ingredient, glycyrrhizic acid, and has a mineralocorticoid-like effect. Chronic intake of licorice induces a syndrome similar to that found in primary hyperaldosteronism. Excessive intake of licorice may cause a hypermineralocorticoidism-like syndrome characterized by sodium and water retention, hypertension, hypokalemia, metabolic alkalosis, low-renin activity, and hypoaldosteronism. In this case report, an association of hypokalemia, edema, and thrombocytopenia that is developed due to the excessive intake of licorice is presented. There are case reports in the literature, which suggest that toxicity findings may emerge with hyperaldosteronism-like manifestations such as hypokalemia, edema, and hypertension. However, any knowledge of thrombocytopenia as a resultant was not encountered among these reported toxic effects. Our case is important because it shows that the excessive intake of licorice may cause a toxic effect in the form of thrombocytopenia. This report is the first presented case to show thrombocytopenia due to licorice syrup consumption.
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Affiliation(s)
- M M Celik
- Department of Internal Medicine, Faculty of Medicine, Mustafa Kemal University, Hatay, Turkey.
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Van Eijk MM, Roes KC, Honing ML, Kuiper MA, Karakus A, Van der JAgt M, Spronk PE, Van Gool WA, Van der Mast RC, Kesecioglu J, Slooter AJ. Effect of rivastigmine as an adjunct to usual care with haloperidol on duration of delirium and mortality in critically ill patients: a multicentre, double-blind, placebo-controlled randomised trial. Crit Care 2011. [PMCID: PMC3067013 DOI: 10.1186/cc9759] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Karakus A, Banga N, Voorn GP, Meinders AJ. Dengue shock syndrome and rhabdomyolysis. Neth J Med 2007; 65:78-81. [PMID: 17379934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Affiliation(s)
- A Karakus
- St. Antonius Hospital, Department of Internal Medicine/Medical Microbiology, Koekoekslaan 1, 3435 CM Nieuwegein, the Netherlands
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Verhaar-Langereis M, Karakus A, van Eijkeren M, Voest E, Witteveen E. Phase II study of the combination of pegylated liposomal doxorubicin and topotecan in platinum-resistant ovarian cancer. Int J Gynecol Cancer 2006; 16:65-70. [PMID: 16445612 DOI: 10.1111/j.1525-1438.2006.00298.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
The combination of liposomal doxorubicin and topotecan was evaluated in a phase II study in patients with platinum-resistant ovarian cancer. Twenty-seven patients received liposomal doxorubicin (30 mg/m(2)) infused at day 1, followed by topotecan (1 mg/m(2)) infusion daily for 5 days. Cycles were repeated every 21 days. This combination regimen showed an overall response rate of 28%. Median time to progression was 30 weeks, with a median overall survival of 40 weeks. Grade 3/4 neutropenia was shown in 70% of patients and grade 3/4 thrombopenia in 41% of patients. Neutropenic fever was reported in 11% of patients. After reviewing the first 12 patients, the internal review board decided to administer topotecan at a dose of 0.75 mg/m(2) and liposomal doxorubicin at 40 mg/m(2) for the remainder of the study. However, this adjustment did not lead to reduction in bone marrow toxicity nor to an improvement in dose intensity. Palmar-plantar erythrodysesthesia and mucositis were more reported in the second cohort but usually mild. The combination of liposomal doxorubicin and topotecan demonstrates favorable response data in platinum-resistant ovarian cancer. However, substantial bone marrow toxicity limits further clinical use.
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Affiliation(s)
- M Verhaar-Langereis
- Section of Medical Oncology and Section of Gynecology, UMC Utrecht, Heidelberglaan 100, 3508 GA Utrecht, The Netherlands
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Rubin G, Levy EI, Scarrow AM, Firlik AD, Karakus A, Wechsler L, Jungreis CA, Yonas H. Remote effects of acute ischemic stroke: A xenon CT cerebral blood flow study. Cerebrovasc Dis 2000; 10:221-8. [PMID: 10773649 DOI: 10.1159/000016060] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The purpose of this study was to verify transhemispheric diaschisis in the early hours after an ischemic event. METHODS XeCT cerebral blood flow (CBF) studies within 8 h of stroke were studied in 23 patients. Mean CBF was evaluated in the ischemic area, contralateral hemisphere and ipsilateral cerebellum. RESULTS A severe CBF reduction was found in the ischemic area (mean 9 +/- 3 ml/100 g/min). The mean CBF in the unaffected hemisphere (33 +/- 10 ml/100 g/min) was 35% less compared to the normal mean value. CBF was decreased in the cerebellum ipsilateral to the stroke (mean 31 +/- 12 ml/100 g/min) suggesting a blood flow depression of the whole brain. CONCLUSIONS During the initial hours of cerebral ischemia, the asymptomatic hemisphere demonstrated CBF depression that was part of the global flow reduction.
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Affiliation(s)
- G Rubin
- Department of Neurosurgery, University of Pittsburgh, Pittsburgh, PA, USA
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Yonas H, Karakus A, Jungreis C, Kassam A, Kromer H, Pindzola R, Pentheny S. CBF reserve based stratification of patients into high and low risk groups for delayed ischemic neurological deficit following subarachnoid hemorrhage. J Stroke Cerebrovasc Dis 1999. [DOI: 10.1016/s1052-3057(99)80109-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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