Studies of enteral nutrition (EN) therapy in patients who require vasopressors are limited. Unfortunately, hemodynamically unstable patients or patients receiving vasopressors were mostly excluded from the large randomized controlled trials in nutrition. We aimed to present the protocol by Hacettepe University Adult Hospital Nutrition Support Team as different approaches to EN of these patients.
Herpes simplex virus is the most common cause of acute sporadic viral encephalitis. Mortality is over 70% in untreated cases. Clinical diagnosis of the disease is difficult. Routine laboratory results are generally nonspecific. Here, we consider the present case worthy to be presented because we demonstrated for the first time that herpes simplex encephalitis may manifest with isolated ninth cranial nerve palsy based on a patient, who presented at the age of 27 years with dysphagia and loss of sense of taste, had MRI and EEG findings consistent with herpes encephalitis, and improved with acyclovir therapy without complication.
Introduction: Thrombocyte indexes (TIN) are biological markers of thrombocyte morphology and function. In critical patients, few studies evaluated TIN relation with disease severity and prognosis. Aim: In this study, we objected to evaluate TIN as a routine feasible parameter at respect of clinical significance to predicting mortality, even though thrombocyte count and functions were prone to alter by variable conditions of critical care unit patients. Materials and methods: Data of 314 patients those with objected parameters out of 347 retrospectively evaluated for TIN relation with clinical surveillance and demographics, in a ten bed capacity mixed-type tertiary CCU in between Jan 1st - 31st Dec 2016. Results: Patients', 194 male (62%), mean age was 62.7 +/- 16.9 (19-86) and APACHE II score was 18.9 +/- 8.5, mean length of stay (LOS) was 9.1 (1-182) days and with 43% mortality. The mean thrombocyte volume (MPV) and dispersion width (PDW) indexes were both correlated each other and positively with disease severity, on the other hand negatively with thrombocyte count. The higher plateletcrit (PCT) levels otherwise lower MPV and PDW were found in males, and also showed relatively lower mortality rates (37.6%<44.1%) (p<0.01). Increrased PDW levels and lower thrombocyte counts were related to higher mortality, in addition to this, PCT<0.17 levels showed 2x higher mortality risk compared to PCT>0.32. Both PDW/PLT and PDW/PCT ratios related to mortality too (p<0.001, p<0.001), otherwise with relatively lower coefficients (r: 0,11, r: 0,10). Conclusion: TIN in mixed type CCUs was assumed as PDW and PCT could be included to disease severity scoring system prognostic biomarkers, like thrombocyte counts.
Background: Recent data have shown that the proportion of older adult patients admitted to intensive care units is increased and the severity of illness is an independent risk factor associated with mortality. The aim of the current study was to compare the prognostic value of the Glasgow Coma Scale (GCS) and GCS-Age Prognosis (GAP) scores in older adult patients (aged >= 65 years) admitted to Medical Intensive Care Unit (MICU). Methods: This was a prospective study of 168 consecutive older adult patients admitted to medical ICU during a 14-month period. For each patient, the GCS and GAP score in the first 24hours of admission and demographic characteristics were calculated and recorded. For statistical analysis, the logistic regression, Receiver operator characteristic (ROC) curve, and Hosmer-Lemeshow test were used (95% confidence interval). Results: Survivors had a significantly higher GCS and GAP scores in the first 24h of MICU admission compared with nonsurvivors (p<0.001, p<0.001, respectively). The discrimination power of both models was good ((area under curve [AUC]:83.8% (standard error [SE]:3%),AUC: 85.4% (SE: 2.9%), respectively). Based on the Hosmer-Lemeshow goodness of fit test, just GCS had an acceptable calibration (x2=13.18, p=0.068). Conclusions: For older adult patients admitted to the MICU, GCS and GAP scores reliably predict outcomes. Based on AUCs the discrimination power of models was good, but the calibration was acceptable just for GCS, thus the GCS is the better predictive model than GAP and useful in determining the prognosis of older adult patients in MICU.
Aim: To determine the prevalence of newly developed low cortisol levels among critically ill medical patients with prolonged or recurrent vasopressor need as well as the factors associated with it. Materials and Methods: This was an observational study which was conducted in a university hospital's medical intensive care unit (ICU) between July 2014 - July 2015. Initial cortisol levels were measured in septic shock patients unresponsive to fluid resuscitation and vasopressors. Patients with initial cortisol levels >= 15 mu g/dl were followed; testing was repeated in patients with ongoing/recurrent vasopressor dependency. Patients were grouped as higher (>= 15 mu g/dl) and lower (<15 mu g/dl) cortisol groups based on repeat testing. Results: Thirty-seven patients had initial cortisol levels >= 15 mu g/dl and 19 patients underwent cortisol retesting for ongoing/recurrent vasopressor need. Mean (+/- SD) age of the patients was 70 +/- 13.5 years. APACHE II and Sequential Organ Failure Assessment scores on ICU admission were 25.3 +/- 6.5 and 10.4 +/- 5.2, respectively. Eleven (%58) were in the lower cortisol group. Age, gender, admission APACHEII and SOFA scores, serum albumin, protein, C-reactive protein and procalcitonin levels at time of admission and repeat sampling were similar between the groups. However, at the time of cortisol retesting, patients with lower cortisol levels had significantly longer length of ICU stay (p=0.038). When glucocorticoid therapy was begun in lower cortisol group, vasopressors were weaned within 48 hours in all. Conclusion: Prolonged or recurrent vasopressor dependency should prompt a search for low cortisol levels in patients with prolonged critical illness, even though prior results were reported to be normal.
