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Aydın S, Mert A, Yılmaz M, Al Maslamani M, Rahimi BA, Ayoade F, El-Kholy A, Belitova M, Sengel BE, Jalal S, Albayrak A, Alatawi JA, Szabo BG, Ganeshan RS, Nsutebu E, Poojary A, Akkoyunlu Y, Alkan S, Elik DB, Eser-Karlidag G, Santos L, Moroti R, Altın N, Gürbüz E, Ulusoy TÜ, Sipahi OR, Çaşkurlu H, Esmaoğlu A, Lakatos B, El-Sayed NM, Marıno A, Cascio A, Mihai A, Dumitru IM, Pshenichnaya N, Ripon RK, Makek MJ, Rashid N, Baljić R, Dascalu C, Sincan G, Kızmaz YU, Madendere B, Erdem H. Understanding clinical outcomes and factors influencing mortality in intensive care unit patients with COVID-19-associated candidemia. Mycoses 2024; 67:e13687. [PMID: 38214425 DOI: 10.1111/myc.13687] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 12/12/2023] [Accepted: 12/18/2023] [Indexed: 01/13/2024]
Abstract
BACKGROUND During the COVID pandemic, research has shown an increase in candidemia cases following severe COVID infection and the identification of risk factors associated with candidemia. However, there is a lack of studies that specifically explore clinical outcomes and mortality rates related to candidemia after COVID infection. OBJECTIVES The aim of this international study was to evaluate the clinical outcomes and identify factors influencing mortality in patients who developed candidemia during their COVID infection. PATIENTS/METHODS This study included adult patients (18 years of age or older) admitted to the intensive care unit (ICU) and diagnosed with COVID-associated candidemia (CAC). The research was conducted through ID-IRI network and in collaboration with 34 medical centres across 18 countries retrospectively, spanning from the beginning of the COVID pandemic until December 2021. RESULTS A total of 293 patients diagnosed with CAC were included. The median age of the patients was 67, and 63% of them were male. The most common Candida species detected was C. albicans. The crude 30-day mortality rate was recorded at 62.4%. The logistic regression analysis identified several factors significantly impacting mortality, including age (odds ratio [OR] 1.04, 95% confidence interval [CI] 1.02-1.07, p < .0005), SOFA score (OR 1.307, 95% CI 1.17-1.45, p < .0005), invasive mechanical ventilation (OR 7.95, 95% CI 1.44-43.83, p < .017) and duration of mechanical ventilation (OR 0.98, 95% CI 0.96-0.99, p < .020). CONCLUSIONS By recognising these prognostic factors, medical professionals can customise their treatment approaches to offer more targeted care, leading to improved patient outcomes and higher survival rates for individuals with COVID-associated candidemia.
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Affiliation(s)
- Selda Aydın
- Department of Infectious Diseases and Clinical Microbiology, Istanbul Medipol University Medical Faculty, Istanbul, Turkey
| | - Ali Mert
- Department of Internal Medicine, Istanbul Medipol University Medical Faculty, Istanbul, Turkey
| | - Mesut Yılmaz
- Department of Infectious Diseases and Clinical Microbiology, Istanbul Medipol University Medical Faculty, Istanbul, Turkey
| | - Muna Al Maslamani
- Department of Infectious Disease, Hamad Medical Corporation and Communicable Disease Center, Hamad Medical Corporation, Doha, Qatar
| | - Bilal Ahmad Rahimi
- Department of Pediatrics, Kandahar University Faculty of Medicine, Kandahar, Afghanistan
| | - Folusakin Ayoade
- Division of Infectious Diseases, Department of Medicine, University of Miami, Miami, Florida, USA
| | - Amani El-Kholy
- Department of Clinical Pathology, Faculty of Medicine, Cairo University, Giza, Egypt
| | - Maya Belitova
- Department of Anesthesiology and Intensive Care, University Hospital Queen Giovanna - ISUL, Medical University of Sofia, Sofia, Bulgaria
| | - Buket Erturk Sengel
- Department of Infectious Disease and Clinical Microbiology, Marmara University Pendik Training and Research Hospital, Istanbul, Turkey
| | - Sabah Jalal
- Department of Internal Medicine, Salmaniya Medical Center, Manama, Bahrain
| | - Ayşe Albayrak
- Department of Infectious Diseases and Clinical Microbiology, Ataturk University Faculty of Medicine, Erzurum, Turkey
| | | | - Balint Gergely Szabo
- South Pest Central Hospital, National Institute of Hematology and Infectious Diseases, Budapest, Hungary
- Semmelweis University, Budapest, Hungary
| | - Ramesh Shankar Ganeshan
- Tropical and Infectious Disease Division, Sheikh Shakhbout Medical City, Abu Dhabi, The United Arab Emirates
| | - Emmanuel Nsutebu
- Tropical and Infectious Disease Division, Sheikh Shakhbout Medical City, Abu Dhabi, The United Arab Emirates
| | - Aruna Poojary
- Department of Clinical Microbiologia, Breach Candy Hospital Trust, Mumbai, India
| | - Yasemin Akkoyunlu
- Department of Infectious Diseases and Clinical Microbiology, Medical Faculty, Bezmialem Vakif University, Istanbul, Turkey
| | - Sevil Alkan
- Department of Infectious Diseases and Clinical Microbiology, Onsekiz Mart University School of Medicine, Canakkale, Turkey
| | - Dilşah Başkol Elik
- Department of Infectious Diseases & Clinical Microbiology, Ege School of Medicine, Izmir, Turkey
| | - Gulden Eser-Karlidag
- Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences, Elazig Fethi Sekin City Hospital, Elazig, Turkey
| | - Lurdes Santos
- Infectious Diseases Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Ruxandra Moroti
- National Institute for Infectious Diseases "Prof. Dr. Matei Bals", Bucharest, Romania
| | - Nilgün Altın
- Department of Infectious Diseases, Dıskapı Yıldırım Beyazıt Training and Research Hospital, University of Health Science Turkey, Istanbul, Turkey
| | - Esra Gürbüz
- Department of Infectious Diseases, Van Training and Research Hospital, University of Health Science Turkey, Van, Turkey
| | - Tülay Ünver Ulusoy
- Department of Infectious Diseases, Dıskapı Yıldırım Beyazıt Training and Research Hospital, University of Health Science Turkey, Istanbul, Turkey
| | - Oğuz Reşat Sipahi
- Department of Infectious Diseases & Clinical Microbiology, Ege School of Medicine, Izmir, Turkey
| | - Hülya Çaşkurlu
- Department of Infectious Diseases and Clinical Microbiology, Istanbul Medeniyet University Faculty of Medicine, Istanbul, Turkey
| | - Aliye Esmaoğlu
- Department of Infectious Diseases and Clinical Microbiology, Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - Botond Lakatos
- South Pest Central Hospital, National Institute of Hematology and Infectious Diseases, Budapest, Hungary
| | | | - Andrea Marıno
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, ARNAS Garibaldi Hospital, University of Catania, Catania, Italy
| | - Antonio Cascio
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) - Infectious Disease Unit, Policlinico "P. Giaccone", University of Palermo, Palermo, Italy
| | - Alexandru Mihai
- National Institute for Infectious Diseases "Prof. Dr. Matei Bals", Bucharest, Romania
| | - Irina Magdalena Dumitru
- Clinical Infectious Diseases Hospital Constanta, Ovidius University of Constanta, Constanta, Romania
| | | | - Rezaul Karim Ripon
- Department of Public Health and Informatics, Jahangirnagar University, Savar, Dhaka, Bangladesh
| | - Mateja Jankovic Makek
- University of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
| | | | - Rusmir Baljić
- Unit for Infectious Disease, Clinical Center of the University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Cosmin Dascalu
- National Institute for Infectious Diseases "Prof. Dr. Matei Bals", Bucharest, Romania
| | - Gülden Sincan
- Department of Haematology, Ataturk University Faculty of Medicine, Erzurum, Turkey
| | - Yeşim Uygun Kızmaz
- Department of Infectıous Diseases and Clinical Microbiology, Istanbul Kosuyolu High Specialization Training and Research Hospital, Istanbul, Turkey
| | - Berk Madendere
- Istanbul Medipol University School of Medicine, Istanbul, Turkey
| | - Hakan Erdem
- Department of Infectious Diseases, Bahrain Oncology Centre, King Hamad University Hospital, Al Sayh, Bahrain
- Department of Infectious Diseases & Clinical Microbiology, Gulhane School of Medicine, Turkish Health Sciences University, Ankara, Turkey
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Güngör S, Ediboğlu Ö, Yazıcıoğlu Moçin Ö, Adıgüzel N, Tuncay E, Ekiz İşcanlı İG, Er B, Karakurt Z, Turan S, Kosovalı BD, Mutlu NM, Kayar D, Gökbulut Bektaş Ş, Uysal E, Seğmen F, Alp G, Erdem D, Has Selmi N, Güven P, Özçelik Z, Ocakcıoğlu M, Yazıcı Özgür C, Yılmaz R, Bilgi Özel D, Cebeci H, Güler B, Cansever C, Çakırca M, İnceöz H, Solmaz İ, Özkan Sipahioğlu F, Aydın EM, Dayanır H, Öner SF, Karatepe U, Özen S, Boran M, Ergül DF, Kasapoğlu US, Delen LA, Toy E, Altun K, Albayrak T, Yanal H, Zaim G, Yarar V, Kılınç G, Deniz M, Özdemir E, Soylu VG, Yılmaz A, Saygılı SM, Öztürk EK, Ergan B, Eyüpoğlu S, Şahin Y, Yüksel B, Bulut A, Sarıtaş A, Yeniay H, Genç M, Kargın F, Özcan O, Karakoç E, Karaca Ü, Sözütek D, Sarı S, Şenoğlu N, Aygün H, Yiğit AC, Kavruk N, Uzan ÇA, Bıçakcıoğlu M, Solak S, Kutbay Özçelik H, Uluç K, Yıldırım İ, Arar MC, Demirel İ, Küver SU, Özgür ES, Aydın K, Erdal Dönmez G, Aygencel G, Esmaoğlu A, Sebil Aydın B, Tokur ME, Korkmaz Ekren P, Aydemir Y, Çakır Güney B, Erdil ÖY, Tünay A, Bahadır T, Uçkun S, Kocaoğlu N, Pınar HU, Kutluer Karaca N, Gültekin H, Ayvat P, Belin Özer A, Eroğlu A, Kuyrukluyıldız U, Baytar Ç, Ayoğlu H, Mızrakçı S, Metin H, Zanbak Mutlu ÖP, Yılmaz H, Tüzüner F. Evaluation of Patients with COVID-19 Followed Up in Intensive Care Units in the Second Year of the Pandemic: A Multicenter Point Prevalence Study. Thorac Res Pract 2023. [PMID: 37994835 DOI: 10.5152/thoracrespract.2023.23024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2023]
Abstract
OBJECTIVE A 1-day point prevalence study was planned to obtain country data by determining the clinical characteristics, follow-up and treatment methods of coronavirus disease 2019 (COVID-19) cases that required intensive care unit (ICU) treatment in the second year of the pandemic. MATERIAL AND METHODS All patients who were hospitalized in the ICUs due to COVID-19 between March 11, 2022, 08.00 am, and March 12, 2022, 08.00 am, were included in the study. Demographic characteristics, intensive care and laboratory data, radiological characteristics, and follow-up results of the patients were recorded. RESULTS A total of 811 patients from 59 centers were included in the study, 59% of the cases were male, and the mean age was 74 ± 14 years. At least one comorbid disease was present in 94% of the cases, and hypertension was the most common. When ICU weight scores were examined, Acute Physiology and Chronic Health Evaluation-II: 19 (15-27) and Sequential Organ Failure Assessment: 7 (4-10) were seen. Sepsis was present in 37% (n = 298) of cases. PaO2/FiO2 ratios of the patients were 190 the highest and 150 the lowest and 51% of the cases were followed via invasive mechanical ventilation. On the study day, 73% bilateral involvement was seen on chest x-ray, and ground-glass opacities (52%) were the most common on chest tomography. There was growth in culture in 40% (n = 318) of the cases, and the most common growth was in the tracheal aspirate (42%). CONCLUSION The clinical course of COVID-19 is variable, and ICU follow-up was required due to advanced age, comorbidity, presence of respiratory symptoms, and widespread radiological involvement. The need for respiratory support and the presence of secondary infection are important issues to be considered in the follow-up. Despite the end of the second year of the pandemic and vaccination, the high severity of the disease as well as the need for follow-up in ICUs has shown that COVID-19 is an important health problem.
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Affiliation(s)
- Sinem Güngör
- Department of Respiratory Intensive Care, University of Health Sciences Süreyyapaşa Chest Diseases and Thoracic Surgery Training and Research Hospital, İstanbul, Turkey
| | - Özlem Ediboğlu
- Department of Intensive Care Unit, University of Health Sciences İzmir Dr. Suat Şeren Chest Diseases and Thoracic Surgery Training and Research Hospital, İzmir, Turkey
| | - Özlem Yazıcıoğlu Moçin
- Department of Respiratory Intensive Care, University of Health Sciences Süreyyapaşa Chest Diseases and Thoracic Surgery Training and Research Hospital, İstanbul, Turkey
| | - Nalan Adıgüzel
- Department of Respiratory Intensive Care, University of Health Sciences Süreyyapaşa Chest Diseases and Thoracic Surgery Training and Research Hospital, İstanbul, Turkey
| | - Eylem Tuncay
- Sancaktepe Şehit Prof. Dr. İlhan Varank Training and Research Hospital, İstanbul, Turkey
| | - İnşa Gül Ekiz İşcanlı
- Department of Respiratory Intensive Care, University of Health Sciences Süreyyapaşa Chest Diseases and Thoracic Surgery Training and Research Hospital, İstanbul, Turkey
| | - Berrin Er
- Medical Intensive Care Unit, Ankara City Hospital, Ankara, Turkey
| | - Zuhal Karakurt
- Department of Respiratory Intensive Care, University of Health Sciences Süreyyapaşa Chest Diseases and Thoracic Surgery Training and Research Hospital, İstanbul, Turkey
| | - Sema Turan
- Medical Intensive Care Unit, Ankara City Hospital, Ankara, Turkey
| | | | - Nevzat Mehmet Mutlu
- Department of Critical Care, University of Health Sciences Ankara City Hospital, Ankara, Turkey
| | - Duygu Kayar
- Medical Intensive Care Unit, Ankara City Hospital, Ankara, Turkey
| | | | - Elmas Uysal
- Medical Intensive Care Unit, Ankara City Hospital, Ankara, Turkey
| | - Fatih Seğmen
- Medical Intensive Care Unit, Ankara City Hospital, Ankara, Turkey
| | - Gürayalp Alp
- Department of Intensive Care, University of Health Sciences Ankara City Hospital, Ankara, Turkey
| | - Deniz Erdem
- Department of Intensive Care, University of Health Sciences Ankara City Hospital, Ankara, Turkey
| | - Nazan Has Selmi
- Medical Intensive Care Unit, Ankara City Hospital, Ankara, Turkey
| | - Pınar Güven
- Department of Intensive Care, Prof. Dr. Feriha Öz Emergency and Pandemic Hospital, İstanbul, Turkey
| | - Zerrin Özçelik
- Department of Intensive Care, Prof. Dr. Feriha Öz Emergency and Pandemic Hospital, İstanbul, Turkey
| | - Merve Ocakcıoğlu
- Sancaktepe Şehit Prof. Dr. İlhan Varank Training and Research Hospital, İstanbul, Turkey
| | - Canan Yazıcı Özgür
- İstanbul Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey
| | - Rabia Yılmaz
- Department of Intensive Care, University of Health Sciences Bakırköy Sadi Konuk Training and Research Hospital, İstanbul, Turkey
| | - Deniz Bilgi Özel
- University of Health Sciences, Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey
| | - Halil Cebeci
- University of Health Sciences, Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey
| | - Bahar Güler
- Department of Intensive Care, University of Health Sciences Bakırköy Sadi Konuk Training and Research Hospital, İstanbul, Turkey
| | - Canan Cansever
- University of Health Sciences Ankara City Hospital, Ankara, Turkey
| | | | - Hansa İnceöz
- University of Health Sciences Gülhane Training and Research Hospital, İstanbul, Turkey
| | - İlker Solmaz
- University of Health Sciences Gülhane Training and Research Hospital, İstanbul, Turkey
| | - Fatma Özkan Sipahioğlu
- Department of Intensive Care, Clinic of Anesthesiology and Reanimation, Ankara Etlik City Hospital, Ankara, Turkey
| | - Eda Macit Aydın
- Department of Intensive Care, Clinic of Anesthesiology and Reanimation, Ankara Etlik City Hospital, Ankara, Turkey
| | - Hakan Dayanır
- University of Health Sciences Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | | | | | - Serkan Özen
- Elazığ Fethi Sekin City Hospital, Elazığ, Turkey
| | - Maruf Boran
- Department of General Intensive Care Unit, Amasya University Sabuncuoğlu Şerafettin Training and Research Hospital, Amasya, Turkey
| | - Dursun Fırat Ergül
- Department of General Intensive Care Unit, Amasya University Sabuncuoğlu Şerafettin Training and Research Hospital, Amasya, Turkey
| | - Umut Sabri Kasapoğlu
- Department of Intensive Care, Marmara University Faculty of Medicine, İstanbul, Turkey
| | - Leman Acun Delen
- Department of Anesthesiology and Reanimation, Malatya Training and Research Hospital, Malatya, Turkey
| | - Erol Toy
- Karabük Training and Research Hospital, Karabük, Turkey
| | - Koray Altun
- Gazi Yaşargil Training and Research Hospital, Diyarbakır, Turkey
| | | | - Hülya Yanal
- Department of Anesthesiology and Reanimation, İlhan Özdemir Public Hospital, Giresun, Turkey
| | - Gizem Zaim
- Giresun Prof. Dr. A. İlhan Özdemir Public Hospital, Giresun, Turkey
| | - Volkan Yarar
- Balıkesir Atatürk City Hospital, Balıkesir, Turkey
| | | | - Mustafa Deniz
- Department of Intensive Care, İzzet Baysal State Hospital, Bolu, Turkey
| | | | - Veysel Garani Soylu
- Department of General Intensive Care, Kastamonu University, Kastamonu, Turkey
| | - Ayşe Yılmaz
- Kastamonu Training and Research Hospital, Kastamonu, Turkey
| | - Saba Mukaddes Saygılı
- Department of Intensive Care Unit, University of Health Sciences İzmir Dr. Suat Şeren Chest Diseases and Thoracic Surgery Training and Research Hospital, İzmir, Turkey
| | - Ejder Kamil Öztürk
- Department of Intensive Care, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Begüm Ergan
- Department of Intensive Care, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | | | - Yiğit Şahin
- Giresun University Training and Research Hospital, Giresun, Turkey
| | - Beyza Yüksel
- Giresun Training and Research Hospital, Giresun, Turkey
| | - Azime Bulut
- Giresun Training and Research Hospital, Giresun, Turkey
| | - Aykut Sarıtaş
- Department of Intensive Care Unit, University of Health Sciences İzmir Tepecik Training and Research Hospital, İzmir, Turkey
| | - Hicret Yeniay
- Department of Intensive Care Unit, University of Health Sciences İzmir Tepecik Training and Research Hospital, İzmir, Turkey
| | - Mürşide Genç
- University of Health Sciences Prof. Dr. Cemil Taşçıoğlu City Hospital, İstanbul, Turkey
| | - Feyza Kargın
- Department of Intensive Care, University of Health Sciences Kartal Lütfi Kırdar Training and Research Hospital, İstanbul, Turkey
| | - Osman Özcan
- Department of Anesthesiology and Reanimation, Eskişehir Osmangazi University, Eskişehir, Turkey
| | - Ebru Karakoç
- Department of Anesthesiology and Reanimation, Eskişehir Osmangazi University, Eskişehir, Turkey
| | - Ümran Karaca
- University of Health Sciences Bursa Yüksek İhtisas Traning and Research Hospital, Bursa, Turkey
| | - Didem Sözütek
- Department of Intensive Care, University of Health Sciences Adana City Hospital, Adana, Turkey
| | - Sema Sarı
- Niğde Training and Research Hospital, Çankaya, Turkey
| | - Nimet Şenoğlu
- Bakırçay University Çiğli Training and Research Hospital, İzmir, Turkey
| | - Hakan Aygün
- Bakırçay University Çiğli Training and Research Hospital, İzmir, Turkey
| | | | - Nilgün Kavruk
- Department of Anesthesiology and Reanimation, University of Health Sciences Antalya Training and Research Hospital, Antalya, Turkey
| | | | - Murat Bıçakcıoğlu
- Department of Anaesthesiology and Reanimation, İnönü University Faculty of Medicine, Malatya, Turkey
| | | | - Hatice Kutbay Özçelik
- University of Health Sciences Yedikule Chest Diseases and Thoracic Surgery Education and Research Hospital, İstanbul, Turkey
| | - Kamuran Uluç
- Department of Anesthesiology and Reanimation, University of Health Sciences Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, İstanbul, Turkey
| | - İlker Yıldırım
- Tekirdağ Namık Kemal University Hospital, Tekirdağ, Turkey
| | | | | | | | - Eylem Sercan Özgür
- Department of Chest Diseases, Mersin University Faculty of Medicine, Mersin, Turkey
| | | | - Gül Erdal Dönmez
- University of Health Sciences Süreyyapaşa Chest Disease and Thoracic Surgery Training and Research Hospital, İstanbul, Turkey
| | - Gülbin Aygencel
- Department of Internal Medicine, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Aliye Esmaoğlu
- Department of Anesthesiology and Reanimation, Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - Berrak Sebil Aydın
- Department of Anesthesiology and Reanimation, Karadeniz Ereğli Public Hospital, Ereğli, Turkey
| | | | - Pervin Korkmaz Ekren
- Department of Pulmonary Disease, Ege University Faculty of Medicine, İzmir, Turkey
| | - Yusuf Aydemir
- Sakarya University Faculty of Medicine, Sakarya, Turkey
| | - Başak Çakır Güney
- University of Health Sciences Sultan Abdulhamid Han Training and Research Hospital, İstanbul, Turkey
| | - Ömer Yavuz Erdil
- Sultan Abdulhamid Han Training and Research Hospital, İstanbul, Turkey
| | - Abdurrahman Tünay
- University of Health Sciences İstanbul Training and Research Hospital, İstanbul, Turkey
| | | | - Serkan Uçkun
- Department of Anaesthesiology and Reanimation, Balıkesir University Faculty of Medicine, Balıkesir, Turkey
| | - Nazan Kocaoğlu
- Department of Anaesthesiology and Reanimation, Balıkesir University Faculty of Medicine, Balıkesir, Turkey
| | - Hüseyin Ulaş Pınar
- Department of Anaesthesiology and Reanimation, KTO Karatay University Faculty of Medicine, Konya, Turkey
| | - Nurcan Kutluer Karaca
- Department of Anaesthesiology and Reanimation, Erzincan Binali Yıldırım University Faculty of Medicine, Erzincan, Turkey
| | - Hamza Gültekin
- Dicle University Faculty of Medicine, Diyarbakır, Turkey
| | - Pınar Ayvat
- İzmir Democracy University Faculty of Medicine, İzmir, Turkey
| | - Ayşe Belin Özer
- Department of Anesthesiology and Reanimation, İnönü University Faculty of Medicine, Malatya, Turkey
| | - Ahmet Eroğlu
- Karadeniz Technical University Faculty of Medicine, Trabzon, Turkey
| | | | - Çağdaş Baytar
- Department of Anaesthesiology and Reanimation, Zonguldak Bülent Ecevit University Faculty of Medicine, Zonguldak, Turkey
| | - Hilal Ayoğlu
- Department of Anaesthesiology and Reanimation, Zonguldak Bülent Ecevit University Faculty of Medicine, Zonguldak, Turkey
| | | | - Hatice Metin
- Erciyes University Faculty of Medicine, Kayseri, Turkey
| | | | - Hakan Yılmaz
- Department of Anesthesiology and Reanimation, Ufuk University Faculty of Medicine, Ankara, Turkey
| | - Filiz Tüzüner
- Department of Anesthesiology and Reanimation, Ufuk University Faculty of Medicine, Ankara, Turkey
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Biçer NS, Türe Z, Ülger B, Esmaoğlu A. A Case of ‘Multi-Inflammatory Syndrome in Children’ Complicated with Cardiogenic Shock. Eur J Ther 2022. [DOI: 10.58600/eurjther-28-4-0074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
SARS Cov-2 infection causes Multi-Inflammatory Syndrome in Children (MIS-C), a serious condition that affects children. We report an 18-year-old Turkish male who was diagnosed with MIS-C and successfully treated. He was diagnosed with MIS-C and required invasive mechanical ventilation due to cardiogenic shock, after what he recovered. With a high temperature, rash, and conjunctival hyperemia, the patient was taken to the emergency department. He had no symptomatic COVID-19 in his medical history, although he had had contact with a COVID-19 positive patient in the near past. Physical examination revealed an erythematous maculopapular rash on the back and neck, as well as hepatosplenomegaly. SARS-CoV-2 IgM and IgG positivity were detected in the rapid antibody test. Following the procedure, rectal bleeding and tachypnea developed. Inflammation indicators and pro-BNP levels both increased. With echocardiogenic examination, the ejection fraction decreased from 50-55 percent to 35%. He needed invasive mechanical ventilation. As a result, the case was classified as MIS-C with predominant cardiac and gastrointestinal involvement. The patient was discharged after a successful multidisciplinary approach. Although COVID-19 infection in children and adolescents is asymptomatic or minimally symptomatic, clinicians should be aware of post-infection autoimmune complications. Keywords: COVID 19, MIS-C, SARS-CoV 2, Cardiogenic Shock
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El-Sokkary R, Uysal S, Erdem H, Kullar R, Pekok AU, Amer F, Grgić S, Carevic B, El-Kholy A, Liskova A, Özdemir M, Khan EA, Uygun-Kizmaz Y, Pandak N, Pandya N, Arapović J, Karaali R, Oztoprak N, Petrov MM, Alabadla R, Alay H, Kholy JAE, Landelle C, Khedr R, Mamtora D, Dragovac G, Fernandez R, Evren EU, Raka L, Cascio A, Dauby N, Oncul A, Balin SO, Cag Y, Dirani N, Dogan M, Dumitru IM, Gad MA, Darazam IA, Naghili B, Del Vecchio RF, Licker M, Marino A, Akhtar N, Kamal M, Angioni G, Medić D, Esmaoğlu A, Gergely SB, Silva-Pinto A, Santos L, Miftode IL, Tekin R, Wongsurakiat P, Khan MA, Kurekci Y, Pilli HP, Grozdanovski K, Miftode E, Baljic R, Vahabolgu H, Rello J. Profiles of multidrug-resistant organisms among patients with bacteremia in intensive care units: an international ID-IRI survey. Eur J Clin Microbiol Infect Dis 2021; 40:2323-2334. [PMID: 34155547 DOI: 10.1007/s10096-021-04288-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [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: 03/28/2021] [Accepted: 06/07/2021] [Indexed: 11/29/2022]
Abstract
Evaluating trends in antibiotic resistance is a requisite. The study aimed to analyze the profile of multidrug-resistant organisms (MDROs) among hospitalized patients with bacteremia in intensive care units (ICUs) in a large geographical area. This is a 1-month cross-sectional survey for blood-borne pathogens in 57 ICUs from 24 countries with different income levels: lower-middle-income (LMI), upper-middle-income (UMI), and high-income (HI) countries. Multidrug-resistant (MDR), extensively drug-resistant (XDR), or pan-drug-resistant isolates were searched. Logistic regression analysis determined resistance predictors among MDROs. Community-acquired infections were comparable to hospital-acquired infections particularly in LMI (94/202; 46.5% vs 108/202; 53.5%). Although MDR (65.1%; 502/771) and XDR (4.9%; 38/771) were common, no pan-drug-resistant isolate was recovered. In total, 32.1% of MDR were Klebsiella pneumoniae, and 55.3% of XDR were Acinetobacter baumannii. The highest MDR and XDR rates were in UMI and LMI, respectively, with no XDR revealed from HI. Predictors of MDR acquisition were male gender (OR, 12.11; 95% CI, 3.025-15.585) and the hospital-acquired origin of bacteremia (OR, 2.643; 95%CI, 1.462-3.894), and XDR acquisition was due to bacteremia in UMI (OR, 3.344; 95%CI, 1.189-5.626) and admission to medical-surgical ICUs (OR, 1.481; 95% CI, 1.076-2.037). We confirm the urgent need to expand stewardship activities to community settings especially in LMI, with more paid attention to the drugs with a higher potential for resistance. Empowering microbiology laboratories and reports to direct prescribing decisions should be prioritized. Supporting stewardship in ICUs, the mixed medical-surgical ones in particular, is warranted.
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Affiliation(s)
- Rehab El-Sokkary
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Serhat Uysal
- Department of Infectious Diseases and Clinical Microbiology, Kanuni Research and Training Hospital, Trabzon, Turkey
| | | | | | | | - Fatma Amer
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Svjetlana Grgić
- Department of Infectious Diseases, University Clinical Hospital Mostar, Mostar, Bosnia and Herzegovina
| | | | - Amani El-Kholy
- Department of Clinical Pathology, Faculty of Medicine, Cairo University, Giza, Egypt
| | - Anna Liskova
- Hospital Nitra, St. Elisabeth University of Health Care and Social Work, Bratislava, Slovak Republic
| | - Mehmet Özdemir
- Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Ejaz Ahmed Khan
- Shifa International Hospital, Islamabad, Shifa Tameer e Millat University, Islamabad, Pakistan
| | - Yesim Uygun-Kizmaz
- Kartal Kosuyolu High Specialization Training and Research Hospital, Istanbul, Turkey
| | | | | | - Jurica Arapović
- Department of Infectious Diseases, University Clinical Hospital Mostar, Mostar, Bosnia and Herzegovina.,School of Medicine, University of Mostar, Mostar, Bosnia and Herzegovina
| | - Rıdvan Karaali
- Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Nefise Oztoprak
- Antalya Training and Research Hospital, Health Sciences University, Antalya, Turkey
| | - Michael M Petrov
- Department of Microbiology and Immunology, Faculty of Pharmacy, Medical University of Plovdiv & "St. George" University Hospital, Plovdiv, Bulgaria
| | | | - Handan Alay
- School of Medicine, Ataturk University, Erzurum, Turkey
| | - Jehan Ali El Kholy
- Department of Anesthesiology and Intensive Care, Faculty of Medicine, Cairo University, Giza, Egypt
| | | | - Reham Khedr
- Department of Pediatric Oncology, National Cancer Institute - Cairo University / Children Cancer Hospital Egypt, Cairo, 57357, Egypt
| | | | - Gorana Dragovac
- Institute of Public Health of Vojvodina, Novi Sad, Serbia & University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia
| | | | - Emine Unal Evren
- Dr. Suat Gunsel Hospital, University of Kyrenia, Kyrenia, Cyprus
| | - Lul Raka
- National Institute of Public Health of Kosova & University "Hasan Prishtina", Prishtina, Kosova
| | - Antonio Cascio
- Infectious and Tropical Disease Unit, AOU Policlinico "P. Giaccone" - Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties - University of Palermo, 90127 , Palermo, Italy
| | - Nicolas Dauby
- Environmental Health Research Centre, Public Health School, Université Libre de Bruxelles (ULB), Department of Infectious Diseases, CHU Saint-Pierre, Brussels, Belgium
| | - Ahsen Oncul
- Sisli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey
| | | | - Yasemin Cag
- Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | | | - Mustafa Dogan
- Namık Kemal University School of Medicine, Tekirdag, Turkey
| | - Irina Magdalena Dumitru
- Clinical Infectious Diseases Hospital Constanta, Ovidius University of Constanta, Constanța, Romania
| | - Maha Ali Gad
- Faculty of Medicine (Kasr Al-Ainy), Cairo University, Cairo, Egypt
| | - Ilad Alavi Darazam
- Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Behrouz Naghili
- Imam Reza Hospital of Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Monica Licker
- Multidisciplinary Research Center on Antimicrobial Resistance, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
| | - Andrea Marino
- ARNAS Garibaldi, Unit of Infectious diseases, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Nasim Akhtar
- Pakistan Institute of Medical Sciences, Islamabad, Pakistan
| | | | | | - Deana Medić
- Institute for Public Health of Vojvodina and University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia
| | - Aliye Esmaoğlu
- Erciyes University Medical Faculty Hospital, Kayseri, Turkey
| | - Szabo Balint Gergely
- South Pest Central Hospital, National Institute of Hematology and Infectious Diseases, Saint Ladislaus Campus, Budapest, Hungary
| | - André Silva-Pinto
- Infectious Diseases Intensive Care Unit, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Lurdes Santos
- Infectious Diseases Intensive Care Unit, Centro Hospitalar Universitário de São João, Porto, Portugal
| | | | - Recep Tekin
- School of Medicine, Dicle University, Diyarbakir, Turkey
| | | | | | | | - Hema Prakash Pilli
- GITAM Institute of Medical Sciences and Research, Department of Microbiology, Rushikonda, Visakhapatnam, India
| | | | - Egidia Miftode
- St. Parascheva" Clinical Hospital of Infectious Diseases, Iasi, Romania
| | | | - Haluk Vahabolgu
- Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - Jordi Rello
- Clinical Research CHRU (Nimes, France) and Vall d'Hebron Institute of Research, Barcelona, Spain
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Talih G, Kantekin ÇÜ, Göçmen Y, Çelik S, Talih T, Esmaoğlu A. Effect of Lingzhi or Reishi Medicinal Mushroom, Ganoderma lucidum (Agaricomycetes), Capsules on Colistin-Induced Nephrotoxicity. Int J Med Mushrooms 2021; 22:445-453. [PMID: 32749099 DOI: 10.1615/intjmedmushrooms.2020034229] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The aim of this experimental study was to investigate the protective effect of Ganoderma lucidum capsules against colistin nephrotoxicity. The study animals were separated into four groups: control, colistin (9 mg/kg), colistin-G. lucidum 50 mg/kg, and colistin-G. lucidum 100 mg/kg. In the colistin group, serum blood urea nitrogen and creatinine values were found to be higher than those of the other groups (p < 0.001). The malondialdehyde, catalase, total oxidative stress, oxidative stress index, and oxidized glutathione values in serum and kidney tissue samples were determined to be higher in the colistin group than in the other groups (p < 0.001). The total antioxidative stress, superoxide dismutase, glutathione peroxidase, and glutathione values measured in the serum and kidney tissue samples were determined to be lower in the colistin group (p < 0.001). Oxidative stress is responsible for tubule damage in colistin nephrotoxicity, and when G. lucidum is used together with colistin, renal damage is reduced.
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Affiliation(s)
- Gamze Talih
- Department of Anesthesiology, School of Medicine, Bozok University, Yozgat, Turkey
| | - Çiğdem Ünal Kantekin
- Department of Anesthesiology, School of Medicine, Bozok University, Yozgat, Turkey
| | - Yeşim Göçmen
- Department of Biochemistry, School of Medicine, Bozok University, Yozgat, Turkey
| | - Sevinç Çelik
- Department of Pathology, School of Medicine, Bozok University, Yozgat, Turkey
| | - Tutkun Talih
- Department of General Surgery, Erciyes University, Medical Faculty, Kayseri, Turkey
| | - Aliye Esmaoğlu
- Department of Anesthesiology, Erciyes University, Medical Faculty, Kayseri, Turkey
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Talih G, Esmaoğlu A, Bayram A, Yazici C, Deniz K, Talih T. Dexmedetomidina impede a nefrotoxicidade da colistina? Braz J Anesthesiol 2018; 68:383-387. [DOI: 10.1016/j.bjan.2018.01.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 01/11/2018] [Accepted: 01/25/2018] [Indexed: 12/31/2022] Open
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Abstract
Background In this study, we aimed to investigate the effect of dexmedetomidine on colistin nephrotoxicity in rats. Methods Thirty-two Wistar albino rats were allocated into four groups. Intraperitoneal (ip) saline at 1 mL.kg−1 was administered to the control group and 10 mg.kg−1 ip colistin was given to the colistin group. In the DEX10 group 10 mcg.kg−1 dexmedetomidine ip was given 20 min before the injection of 10 mg.kg−1 ip colistin. In the DEX20 group ip 20 mcg.kg−1 dexmedetomidine was injected 20 min before the administration of 10 mg.kg−1 ip colistin. These treatments were continued twice a day for seven days. Samples were taken on the eighth day. BUN, Cr, KIM-1, TAS, and TOS were examined in blood samples and caspase-3 was examined in kidney tissue samples. Results The values for BUN, Cr and TOS were significantly higher in the colistin group than in the control group. BUN, Cr and TOS changes in the DEX10 and DEX20 groups were not significant compared with the control group but they were significantly lower compared with the colistin group. TAS values in the DEX10 group were significantly lower than in the control group. Apoptotic activity was significantly higher in the colistin group compared with the control group, but there was no significant difference in terms of caspase-3 staining activity when DEX10 and DEX20 groups were compared with the control group. Conclusion Oxidative damage and apoptosis played roles in colistin nephrotoxicity, and colistin nephrotoxicity could be prevented by treatment with dexmedetomidine.
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Affiliation(s)
- Gamze Talih
- Akcakale State Hospital, Department of Anesthesiology and Reanimation, Şanlıurfa, Turquia
| | - Aliye Esmaoğlu
- Erciyes University, Medical Faculty, Department of Anesthesiology and Reanimation, Kayseri, Turquia.
| | - Adnan Bayram
- Erciyes University, Medical Faculty, Department of Anesthesiology and Reanimation, Kayseri, Turquia
| | - Cevat Yazici
- Erciyes University, Medical Faculty, Department of Biochemistry, Kayseri, Turquia
| | - Kemal Deniz
- Erciyes University, Medical Faculty, Department of Pathology, Kayseri, Turquia
| | - Tutkun Talih
- Akcakale State Hospital, Department of General Surgery, Şanlıurfa, Turquia
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Alp E, Eren E, Elay G, Cevahir F, Esmaoğlu A, Rello J. Efficacy of loading dose of colistin in Acinetobacter baumannii ventilator-associated pneumonia. Infez Med 2017; 25:311-319. [PMID: 29286009] [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
Colistin loading dose (LD) has been postulated as an advance in therapy. The clinical, microbiological effectiveness and nephrotoxicity of adding an LD to systemic colistin in ventilator-associated pneumonia (VAP) caused by multidrug-resistant (MDR) Acinetobacter baumannii remain unknown. In this quasi experimental study, the efficacy, outcomes and nephrotoxicity in 30 adults who received intravenous colistin with LD for MDR A. baumannii ventilator associated pneumonia were compared with 22 in absence of LD. Adding LD, the clinical cure rate at 14 days of therapy increased from 47.6% to 56.7% (p>0.397). No significant differences in bacteriological clearance (80 vs 81%), ICU mortality (50% vs 54.2%) or ICU length of stay (median: 32 vs 36 days) were identified. Mortality increased (76.2% vs 35.5%, p=0.004) in patients with nephrotoxicity, with age (median 67.0 vs. 50.0 years, p=0.002) being the only risk factor for nephrotoxicity. The nephrotoxicity rate increased from 27.3% in absence of LD to 35.3% with LD and SOFA <8, and 69.2% (p= 0.065) with LD and SOFA >7. Overall, nephrotoxicity was more severe in the LD group according to RIFLE criteria (p=0.015). Adding LD to systemic colistin for MDR A. baumannii VAP had no significant effect on clinical cure rates, bacteriologic clearance or pre-defined outcomes. However, the nephrotoxicity rate increased with LD, with special risk in adults with high organ failure development or advanced age. Further evidence regarding the risks and benefits of LD is required. The development of newer agents and strategies is urgently needed.
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Affiliation(s)
- Emine Alp
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Erciyes University, Erciyes, Turkey: Infection Control Committee, Faculty of Medicine, Erciyes University, Erciyes, Turkey
| | - Esma Eren
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Erciyes University, Erciyes, Turkey
| | - Gülseren Elay
- Department of Internal Medicine, Intensive Care Unit, Faculty of Medicine, Erciyes University, Erciyes, Turkey
| | - Fatma Cevahir
- Infection Control Committee, Faculty of Medicine, Erciyes University, Erciyes, Turkey
| | - Aliye Esmaoğlu
- Department of Anesthesiology and Reanimation, Intensive Care Unit, Faculty of Medicine, Erciyes University, Erciyes, Turkey
| | - Jordi Rello
- Critical Care Department, Hospital Vall d'Hebron, CIBERES, Universitat Autonoma de Barcelona, Barcelona, Spain
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9
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Bayram A, Ulgey A, Güneş I, Ketenci I, Capar A, Esmaoğlu A, Boyacı A. [Comparison between magnesium sulfate and dexmedetomidine in controlled hypotension during functional endoscopic sinus surgery]. Rev Bras Anestesiol 2014; 65:61-7. [PMID: 25497751 DOI: 10.1016/j.bjan.2014.04.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [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: 12/09/2013] [Accepted: 04/27/2014] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND AND OBJECTIVES It is crucial to decrease bleeding during functional endoscopic sinus surgery. Our primary goal was to investigate the effects of magnesium sulfate and dexmedetomidine used for controlled hypotension on the visibility of the surgical site. METHODS 60 patients aged between 18 and 65 years were enrolled. In the magnesium sulfate group (Group M), patients were administered 40mg/kg magnesium sulfate in 100mL saline solution over 10min as the intravenous loading dose 10min before induction, with a subsequent 10-15mg/kg/h infusion during surgery. In the dexmedetomidine group (Group D), patients were administered 1μg/kg dexmedetomidine in 100mL saline solution as the loading dose 10min before surgery and 0.5-1μg/kg/h dexmedetomidine during surgery. Deliberate hypotension was defined as a mean arterial pressure of 60-70mmHg. RESULTS Bleeding score was significantly decreased in Group D (p=0.002). Mean arterial pressure values were significantly decreased in Group D compared to that in Group M, except for the initial stage, after induction and 5min after intubation (p<0.05). The number of patients who required nitroglycerine was significantly lower in Group D (p=0.01) and surgeon satisfaction was significantly increased in the same group (p=0.001). Aldrete recovery score ≥9 duration was significantly shorter in Group D (p=0.001). There was no difference between the two groups in terms of recovery room verbal numerical rating scale. CONCLUSIONS Dexmedetomidine can provide more effective controlled hypotension and thus contribute to improved visibility of the surgical site.
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Affiliation(s)
- Adnan Bayram
- Departamento de Anestesiologia, Medical Faculty, Erciyes University, Kayseri, Turquia.
| | - Ayşe Ulgey
- Departamento de Anestesiologia, Medical Faculty, Erciyes University, Kayseri, Turquia
| | - Işın Güneş
- Departamento de Anestesiologia, Medical Faculty, Erciyes University, Kayseri, Turquia
| | - Ibrahim Ketenci
- Departamento de Otorrinolaringologia, Medical Faculty, Erciyes University, Kayseri, Turquia
| | - Ayşe Capar
- Departamento de Anestesiologia, Medical Faculty, Erciyes University, Kayseri, Turquia
| | - Aliye Esmaoğlu
- Departamento de Anestesiologia, Medical Faculty, Erciyes University, Kayseri, Turquia
| | - Adem Boyacı
- Departamento de Anestesiologia, Medical Faculty, Erciyes University, Kayseri, Turquia
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Aksu R, Akin A, Biçer C, Esmaoğlu A, Tosun Z, Boyaci A. Comparison of the effects of dexmedetomidine versus fentanyl on airway reflexes and hemodynamic responses to tracheal extubation during rhinoplasty: A double-blind, randomized, controlled study. Curr Ther Res Clin Exp 2014; 70:209-20. [PMID: 24683231 DOI: 10.1016/j.curtheres.2009.06.003] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2009] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Stimulation of various sites, from the nasal mucosa to the diaphragm, can evoke laryngospasm. To reduce airway reflexes, tracheal extubation should be performed while the patient is deeply anesthetized or with drugs that do not depress ventilation. However, tracheal extubation during rhinoplasty may be difficult because of the aspiration of blood and the possibility of laryngospasm. Dexmedetomidine and fentanyl both have sedative and analgesic effects, but dexmedetomidine has been reported to induce sedation without affecting respiratory status. OBJECTIVE The aim of this study was to compare the effects of dexmedetomidine and fentanyl on airway reflexes and hemodynamic responses to tracheal extubation in patients undergoing rhinoplasty. METHODS This double-blind, randomized, controlled study was conducted at the Erciyes University Medical Center, Kayseri, Turkey. Patients classified as American Society of Anesthesiologists physical status I or II who were undergoing elective rhinoplasty between January 2007 and June 2007 with general anesthesia were eligible for study entry. Using a sealed-envelope method, the patients were randomly divided into 2 groups (20 patients per group). Five minutes before extubation, patients received either dexmedetomidine 0.5 μg/kg in 100 mL of isotonic saline or fentanyl 1 μg/kg in 100 mL of isotonic saline intravenously. All patients were extubated by anesthesiologists who were blinded to the study drugs, and all were continuously monitored for 15 minutes after extubation. Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and oxygen saturation using pulse oximetry (SpO2) were recorded before anesthesia, after drug administration, after skin incision, at the completion of surgery, and 1, 5, and 10 minutes before and after tracheal extubation. Any prevalence of laryngospasm, bronchospasm, or desaturation was recorded. RESULTS Forty patients (25 men, 15 women; mean [SD] age, 24.86 [7.43] years) were included in the study. Dexmedetomidine was associated with a significant increase in extubation quality compared with fentanyl, reflected in the prevalence of cough after extubation (85% [17/20] vs 30% [6/20] of patients, respectively; P = 0.001). There were no clinically significant decreases in HR, SBP, DBP, or SpO2 after extubation with dexmedetomidine or fentanyl. In the dexmedetomidine group, HR was not significantly increased after extubation; however, in the fentanyl group, HR was significantly increased compared with the preextubation values (all, P = 0.007). HR was significantly higher in the fentanyl group compared with the dexmedetomidine group at 1, 5, and 10 minutes after extubation (all, P = 0.003). Compared with preextubation values, SBP was significantly increased at 1 and 5 minutes after extubation in the dexmedetomidine group (both, P = 0.033) and at 1, 5, and 10 minutes after extubation in the fentanyl group (all, P = 0.033). The postoperative sedation scores and the extubation, awakening, and orientation times were not significantly different between the 2 groups. In the dexmedetomidine group, bradycardia (HR <45 beats/min) was observed in 2 patients and emesis was observed in 2 patients. In the fentanyl group, emesis was observed in 3 patients, bradycardia in 2 patients, vomiting in 1 patient, and shivering in 1 patient; vertigo was reported in 1 patient. There were no significant differences in the prevalence of adverse events between the 2 groups. CONCLUSION The findings in the present study suggest that dexmedetomidine 0.5 μg/kg IV, administered before extubation, was more effective in attenuating airway reflex responses to tracheal extubation and maintaining hemodynamic stability without prolonging recovery compared with fentanyl 1 μg/kg IV in these patients undergoing rhinoplasty.
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Affiliation(s)
- Recep Aksu
- Department of Anesthesiology, Erciyes University School of Medicine, Kayseri, Turkey
| | - Aynur Akin
- Department of Anesthesiology, Erciyes University School of Medicine, Kayseri, Turkey
| | - Cihangir Biçer
- Department of Anesthesiology, Erciyes University School of Medicine, Kayseri, Turkey
| | - Aliye Esmaoğlu
- Department of Anesthesiology, Erciyes University School of Medicine, Kayseri, Turkey
| | - Zeynep Tosun
- Department of Anesthesiology, Erciyes University School of Medicine, Kayseri, Turkey
| | - Adem Boyaci
- Department of Anesthesiology, Erciyes University School of Medicine, Kayseri, Turkey
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Esmaoğlu A, Türk S, Bayram A, Akın A, Uğur F, Ulgey A. The effects of dexmedetomidine added to spinal levobupivacaine for transurethral endoscopic surgery. Balkan Med J 2013; 30:186-90. [PMID: 25207098 DOI: 10.5152/balkanmedj.2013.7082] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [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: 06/05/2012] [Accepted: 12/15/2013] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Intrathecal α2 agonists prolong the duration of action of local anesthetics and reduce the required dose. Dexmedetomidine is an α2 receptor agonist and its α2/α1 selectivity is 8 times higher than that of clonidine. AIMS In this study, we aimed to investigate the effect of adding dexmedetomidine to intrathecal levobupivacaine on the onset time and duration of motor and sensory blocks. STUDY DESIGN Randomized controlled study. METHODS Patients were randomly assigned into two groups. Group L (n= 30) patients received 3 mL (15 mg) of 0.5% levobupivacaine +0.3 mL normal saline and Group LD (n= 30) patients received 3 mL (15 mg) of 0.5% levobupivacaine + 0.3 mL (3 μg) dexmedetomidine. Sensory block onset time, block reaching time to T10 dermatome, the most elevated dermatome level, two dermatome regression time, sensory block complete regression time as well as motor block onset time, reaching Bromage 3 and regressing to Bromage 0 were recorded. RESULTS Sensory and motor block onset times were shorter in Group LD than in Group L (p<0.001). The regression of the sensory block to S1 dermatome and Bromage 0 were longer in Group LD than Group L (p<0.001). The two dermatome regression time was longer in Group LD than Group L (p< 0.001). There were no statistically significant differences between groups in blood pressure and heart rate. There was no statistically significant difference between groups when adverse effects were compared. CONCLUSION We conclude that intrathecal dexmedetomidine addition to levobupivacaine for spinal anaesthesia shortens sensory and motor block onset time and prolongs block duration without any significant adverse effects.
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Affiliation(s)
- Aliye Esmaoğlu
- Department of Anesthesiology and Reanimation, Erciyes University Medical Faculty, Kayseri, Turkey
| | - Sümeyra Türk
- Clinic of Anesthesiology and Reanimation, Kayseri Training and Research Hospital, Kayseri, Turkey
| | - Adnan Bayram
- Department of Anesthesiology and Reanimation, Erciyes University Medical Faculty, Kayseri, Turkey
| | - Aynur Akın
- Department of Anesthesiology and Reanimation, Erciyes University Medical Faculty, Kayseri, Turkey
| | - Fatih Uğur
- Department of Anesthesiology and Reanimation, Erciyes University Medical Faculty, Kayseri, Turkey
| | - Ayşe Ulgey
- Department of Anesthesiology and Reanimation, Erciyes University Medical Faculty, Kayseri, Turkey
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Uğur F, Akin A, Esmaoğlu A, Doğru K, Ors S, Aydoğan H, Gülcü N, Boyaci A. [Comparison of phantom limb pain or phantom extremity sensation of upper and lower extremity amputations]. Agri 2007; 19:50-6. [PMID: 17457707] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
The aim of this retrospective study is to evaluate the upper and the lower extremity amputations with regard to phantom pain, phantom sensation and stump pain. A questionnaire consisting of 23 questions was send to the patients who underwent upper or lower extremity amputation surgery between 1996- 2005. The patients were questioned for the presence of phantom pain and sensations and if they existed for the frequency, intensity, cause of amputation, pre-amputation pain, stump pain, usage of artificial limb. Totally 147 patients were included and the response rate was 70 %. The incidence of phantom pain in Upper Extremity Group was 60 % and 65.8% in Lower Extremity Group. The incidence of phantom sensations was 70.7% in Upper Extremity Group and 75.6% in Lower Extremity Group. There was no significant difference between two groups considering in phantom pain and phantom sensations. The phantom pain was significantly higher in patients who lost dominant hand, experienced pre amputation pain and suffered stump pain. There were no significant differences in regard to phantom pain and sensation between upper and lower extremity amputations. However the presence of preamputation pain, stump pain and amputation of dominant hand were found as risk factors for the development of phantom pain.
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Affiliation(s)
- Fatih Uğur
- Erciyes University Medical Faculty, Kayseri, Turkey.
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Abstract
BACKGROUND AND AIM This study determines whether epidural fentanyl given before incision decreases the requirements for opioid analgesia postoperatively, compared with the same dose of epidural fentanyl given after the surgery. METHODS Forty patients scheduled to undergo elective abdominal surgery were randomly allocated between two groups according to the time of administered of fentanyl. None of the patients in either group received premedication. Prior to induction of general anaesthesia an epidural catheter was inserted at the L2-3 interspace and flushed with 0.9% NaCl. Patients then received 100 micrograms fentanyl in 10 mL 0.9% NaCl through this catheter either 15 min before awaking at the end of the operation (group I), or else the same dose given at an estimated time of 15 min before the start of surgery (group II). Postoperative analgesia consisted of patient-controlled intravenous fentanyl. The amount of fentanyl used by the patients was noted at 2, 4, 8, 12 and 24 h after surgery. Pain scores and sedation scores were assessed at 0, 2, 4, 8, 12 and 24 h postoperatively. RESULTS The consumption of fentanyl was similar in both groups in all studied periods postoperatively. The mean pain score was lower for patients in group I than group II immediately after operation. There were no statistically significant differences between the mean pain scores of groups at 2, 4, 8, 12 and 24 h after operation. Mean sedation scores were similar in both groups at all times postoperatively. CONCLUSION This study showed that the dose of fentanyl administered epidurally prior to surgical incision did not produce any clinically useful pre-emptive analgesic effect.
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Affiliation(s)
- A Esmaoğlu
- Department of Anaesthesiology, University Hospital of Erciyes, Kayseri, Turkey.
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14
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Abstract
BACKGROUND The dosage of local anaesthetic and the time the patient must be kept in the lateral decubitus position for a unilateral spinal anaesthesia is not known. The aim of this study was to determine the ideal dosage of hyperbaric bupivacaine and the time required for the lateral decubitus position for a unilateral spinal block. METHODS Ninety patients who were scheduled to receive spinal block for surgery in the lower extremity were randomised into 9 groups (n = 10). The spinal block was performed through the L4-L5 intervertebral space with the patient in the lateral decubitus position. Patients in groups Ia, Ib, Ic; IIa, IIb, IIc; IIIa, IIIb, IIIc received 1.5 ml of 0.5%, 2 ml of 0.5%, and 2.5 ml of 0.5% hyperbaric bupivacaine solutions, respectively. The patients were turned to the supine position for 5 min after the injection in groups Ia, IIa, IIIa, 10 min after the injection in groups Ib, IIb, IIIb, and 15 min after the injection in groups Ic, IIc, IIIc. The onset and regression of sensory and motor block were checked and compared between the dependent and non-dependent sides in each group. RESULTS The rate of block progression of the non-dependent side was higher in the groups receiving 2.5 ml 0.5% hyperbaric bupivacaine solution than in the other groups; at the same time the level of block was higher and the duration of block was longer. The incidence of hypotension was 10-20% in these groups. In the 2 ml 0.5% hyperbaric bupivacaine solution groups, a satisfactory block level and duration of anaesthesia for surgery was obtained. The rate of block progression to non-dependent side in the groups receiving 1.5 ml of 0.5% hyperbaric bupivacaine solution was lower than the other groups, but the duration of block was shorter and the level of block was lower than the other groups. CONCLUSION For unilateral spinal anaesthesia in lower extremity operations, 2ml 0.5% hyperbaric bupivacaine solution for operations above the knee and 1.5 ml 0.5% hyperbaric bupivacaine solution for operations below the knee and keeping the patients for 10 min in the lateral decubitus position were found to be appropriate.
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Affiliation(s)
- A Esmaoğlu
- Department of Anesthesiology, University Hospital of Erciyes, Kayseri, Turkey
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Esmaoğlu A, Boyaci A, Ersoy Ö, Güler G, Talo R, Tercan E. A.241 Unilateral spinal anaesthesia with hyperbaric bupivacaine. Br J Anaesth 1996. [DOI: 10.1016/s0007-0912(18)31096-1] [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: 11/29/2022] Open
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Abstract
Morphine-ephedrine interaction on analgesia was studied in mice (n = 240) and in post-operative patients (n = 32). It was found that combining morphine and ephedrine enhances analgesia which is not significantly different from the effect of morphine given alone at double dose.
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Affiliation(s)
- Y Tekol
- Department of Pharmacology, Erciyes University, Medical Faculty, Kayseri, Turkey
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