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    The Association of Macrophage Activation-Like Syndrome with Mortality in Elderly Patients with Sepsis
    (Bilimsel Tip Yayinevi, 2023) Bozgul, Sukriye Miray Kilincer; Acar, Caner; Kurtulmus, Ilkce Akgun; Aydin, Ozgur; Koca, Didem; Ak, Gunes; Cilli, Fatma Feriha
    Introduction: Among the geriatric population, when compared to younger individuals, mortality is high. Macrophage activation-like syndrome (MALS) has been reported to be an independent immunological entity associated with mortality among sepsis patients in adults which represents the increased inflammation state. This study aimed to investigate the frequency of MALS in elderly sepsis patients and its association with intensive care unit (ICU) mortality. Materials and Methods: This retrospective study included patients aged 65 years or older with sepsis between January 2013 and January 2022 in the ICU of the Internal Medicine Department of Ege University Hospital. MALS was diagnosed with a hemophagocytic syndrome score (H-score) of =151 and/or co-presence of hepatobiliary dysfunction (HBD) and disseminated intravascular coagulation (DIC). Clinical, demographic, and laboratory results were retrieved from the medical records. Factors affecting ICU mortality were investigated with binary logistic regression analysis. Results: In our study of 194 patients, mortality was 46.4% and MALS frequency was 23.7%. Among non-survivors, MALS frequency was significantly higher than survivors; 32.2% and 16.3%, p= 0.010. The median H-score was 117 in non-survivors and 78.5 in survivors, p= 0.002. ICU mortality of elderly sepsis patients increased by approximately 25 times when MALS was present. Age was not identified as a risk factor for ICU mortality. Conclusion: Among elderly sepsis patients, the frequency of MALS was found to be remarkably high in our single-center study. MALS may be one of the reasons for increased mortality in elderly sepsis patients.
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    A Case of Plasmodium vivax Complicated with Reactive Hemophagocytic Syndrome
    (Ankara Microbiology Soc, 2022) Havvat, Nebil; Kurtulmus, Ilkce Akgun; Gunes, Ajda; Zorbozan, Orcun; Kilincer Bozgul, Sukriye Miray; Bozkurt, Devrim
    Plasmodium vivax is the most common malaria agent in the world, transmitted by vectoring of anopheles mosquitoes. In the clinical course of the disease, non-specific signs of infection (fever, myalgia, joint pain, nausea, vomiting, etc.) can be seen. Hemophagocytic lymphohistiocytosis; also known as hemophagocytic syndrome, is a rapid-onset and life-threatening clinical condition that develops as a result of uncontrolled immune activation and hypercytokinemia. In this case report, a case who developed hemophagocytic syndrome while under treatment for P.vivax infection was presented. A 37-year-old male patient applied to us with the complaints of high fever, chills-shivering and weakness, started on his return from Sudan. Upon admission, the fever was 40 degrees C, the pulse was rhythmic and 115/minute, the respiratory rate was 24/minute, and the blood pressure was 80/49 mmHg, and he was followed up in the intensive care unit due to the signs of systemic inflammatory response syndrome. During the investigation of the etiology of fever, it was learned that he did not receive prophylaxis for malaria during his stay in Sudan. Thin and thick blood smears were examined. P.vivax infection was detected in the patient and the treatment was initiated, a bone marrow aspiration biopsy was performed with the prediagnosis of hemophagocytic syndrome with persistent fever, deepening of thrombocytopenia, findings of hyperferritinemia, hypertriglyceridemia, hepatosplenomegaly, and myeloid serial hemophagocytosis in the 48th hour of the treatment. In addition to antimalarial therapy, clinical and laboratory response was obtained with polyclonal intravenous immunoglobulin (IVIG) therapy.
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    A Case of Taenia saginata Infestation Presenting with Chronic Constipation
    (Bilimsel Tip Yayinevi, 2023) Kurtulmus, Ilkce Akgun; Buyruk, Abdullah Murat; Ozutemiz, Ahmet Omer
    Taenia saginata is a parasitic infectious agent of the cestode class, which is transmitted to humans by the raw consumption of beef containing the larvae of Cysticercus bovis. Although the infection is usually asymptomatic in humans, it can cause symptoms such as nausea, vomiting, diarrhea, weight loss, and swelling in the abdomen. Chronic constipation, according to the Rome IV classification criteria, is a gastroenterological condition characterized by straining during defecation, infrequent defecation, and a sense of incomplete rectal emptying persisting for at least six months. This case report aims to highlight the concurrent infestation of Taenia saginata and the improvement in constipation symptoms after treatment in a patient who had been presenting to our outpatient clinic with chronic constipation for four years.
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    Comparison of non-COVID-19 critically ill patients between pre-pandemic and pandemic period admitted from emergency department to internal medicine intensive care unit
    (2024) Bozgul, Sukriye Miray Kilincer; Kurtulmus, Ilkce Akgun; Zihni, Figen Yargucu; Yilmaz, Mumtaz; Akarca, Funda Karbek; Aydoğan, Deniz Can; Ozkilic, Baris
    Aim: During the COVID-19 pandemic, a large number of intensive care unit beds have been organized for critically ill COVID-19 patients. However, the need for intensive care for non-COVID-19 critical patients continues. In our study, we aimed to compare non-COVID-19 critically ill patients admitted to the internal medicine intensive care unit from the emergency department before and during the pandemic period. Materials and Methods: Patients who were admitted to the internal medicine intensive care unit from the emergency department were grouped as pre-pandemic (March 2018-March 2020) and during the pandemic (March 2020-March 2022) and compared retrospectively in terms of the number of hospitalisations, demographic characteristics, length of intensive care unit stay and mortality. Results: The number of emergency department patient admissions other than surgical reasons was 579.657 during the study period. 63.33 % of these patients were admitted before the pandemic and 36.67% during the pandemic period. The number of patients included in our study was 493 before the pandemic and 460 during the pandemic period. Median age was 61 (30) in the pre-pandemic period and 64 (26.8) in the pandemic period, p=0.022. There was no significant difference in terms of comorbidities. The main reason for hospitalization was similar and sepsis was the leading reason for hospitalization. The frequency of acute renal failure in intensive care unit was significantly higher during the pandemic period. Mortality was 25.2% before the pandemic and 24.3% during the pandemic period, p=0.760. Conclusion: Although emergency department admissions decreased, the number of non-COVID-19 internal medicine intensive care unit hospitalizations did not decrease. This situation reveals the importance of organizing intensive care beds for hospitalization for non-COVID-19 reasons in order not to disrupt health services during the pandemic period.
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    Lactate level is an independent predictor of mortality in patients with hematologic malignancy receiving urgent chemotherapy in intensive care unit
    (Elsevier France-Editions Scientifiques Medicales Elsevier, 2024) Bozgul, Sukriye Miray Kilincer; Kurtulmus, Ilkce Akgun; Gunes, Ajda; Koymen, Gorkem; Bozkurt, Devrim; Karaman, Zehra Tuba; Islamoglu, Karya
    Background: Intensive care unit (ICU) survival of cancer patients has improved. Urgent chemotherapy has become feasible in critically ill patients with specific organ dysfunction due to hematological malignancies. Objective: The aim of the study was to assess ICU mortality rates and the factors associated with mortality in patients with hematologic malignancies receiving urgent chemotherapy in the ICU. Methods: We retrospectively included all patients admitted to the ICU who received chemotherapy due to hematologic malignancy in 2012-2022. Results: Of the 129 patients undergoing chemotherapy in the ICU, 50 (38.7 %) died during the ICU follow-up. The following conditions were significantly more common among nonsurvivors: presence of infection at the time of ICU admission (p < 0.001), the requirement for mechanical ventilation during ICU stay (p < 0.001), the need for noninvasive mechanical ventilation during ICU stay (p = 0.014), vasopressor support (p < 0.001), and sepsis (p < 0.001). Logistic regression analysis revealed that among laboratory parameters on ICU admission, lactate (p = 0.008), albumin (p = 0.022), C-reactive protein (p = 0.046), baseline sequential organ failure assessment (SOFA) score (p < 0.001), newly developed heart failure (p = 0.006), and the requirement for vasopressor agents during ICU stay (p < 0.001) significantly influenced the risk of mortality in the univariate analysis. The multivariate analysis revealed lactate levels (p = 0.047) on ICU admission as an independent predictor of mortality. Conclusion: The development of heart failure and lactate levels on admission were the main predictors of mortality. Additionally, higher SOFA scores revealed that illness severity was closely associated with mortality. Future studies should focus on strategies to further reduce these risks and achieve the best outcomes for these patients.