Foreign bodies that strike the body with their long edges can cause severe problems. From the hospitalization of the patients to the removal of the foreign body and from surgery to follow-up, working as a team in a well-organized manner is necessary. In the present research, we present our experience, including the hospitalization, initial assessment by the emergency team, examination, and treatment plan, of a pediatric patient who had a 12-m long iron bar that traversed from the right side of the anus to the loin; this impalement happened while the patient was sliding through a snow-covered street, and the patient had to wait on the snow until the fire department arrived and cut the iron bar.

<b><i>Background:</i></b> Influenza can cause severe acute respiratory illness (SARI), which occurs as local outbreaks or seasonal epidemics with high intensive care unit (ICU) admission and mortality rates. Mortality is mainly due to SARI. <b><i>Objective:</i></b> The aim of this study was to evaluate the outcome of patients admitted to ICU due to influenza-related SARI in 2017–2018 flu season in Turkey. <b><i>Methods:</i></b> A retrospective multicenter study was conducted in 13 ICUs with a total of 216 beds from 6 cities in Turkey. All adult patients (over 18 years) admitted to the ICUs in 2017–2018 flu season (between September 1, 2017, and April 30, 2018) because of SARI and with a positive nasopharyngeal swab for influenza were included in the study. <b><i>Results:</i></b> A total of 123 cases were included in the study. The mean age of patients was 64.5 ± 17.5 years, and 66 (53.7%) patients were older than 65 years. The ICU mortality was 33.9%, and hospital mortality was 35.6%. Invasive mechanical ventilation (IMV), acute kidney injury (AKI), hematologic malignancy, and &#x3e;65 years of age were the factors affecting mortality in influenza. <b><i>Conclusion:</i></b> SARI due to influenza carries a high mortality rate, and IMV, AKI, presence of hematologic malignancy, and older age are independent risk factors for mortality.

BACKGROUND:The aim of the present study was to evaluate the effectiveness of the Simplified Acute Physiology Score (SAPS) III and the Acute Physiology and Chronic Health Evaluation (APACHE) IV in the prediction of in-hospital mortality in surviving multitrauma patients. METHODS:This study was conducted in the 13-bed intensive care unit (ICU) of a tertiary hospital. A retrospective review of multitrauma patients whose care was managed in the ICU was performed. Data collection included details of age, gender, ICU admission, and outcome. APACHE IV and SAPS III scores, as well as the predicted mortality rate (PMR), were calculated using web-based calculators. RESULTS:Of the 90 patients 20% (n=18) were female and 80% (n=72) were male. The overall mortality rate was 25.6%. The mean APACHE IV, Acute Physiology Score (APS) and SAPS III score was 69.27±34.51, 66.42±33.72, and 26.36±27.14, respectively. The mean PMR according to the APACHE IV and the SAPS III was 26.36±27.14 and 17.07±24.88, respectively. The area under the curve result of receiver operating characteristic curve analysis was 0.87 for the APACHE IV and 0.93 for the SAPS III. CONCLUSION:The performance of the SAPS III was more sensitive and discriminative than the APACHE IV scoring system for multi-trauma ICU patients.

Objective: The aim of the study was to evaluate the nutritional status of patients aged ≥65 years admitted to the intensive care unit (ICU), compare the compliance with the nutritional status screening tools, and determine the effect of malnutrition on mortality. Methods: Patients who were admitted to ICU and could receive nutrition orally were included into this study.  The Nutritional Risk Score 2002 (NRS-2002) and Mini Nutritional Assessment Short Form (MNA-SF) were administered, and the Nutritional Risk Index and Geriatric Nutritional Risk Index (GNRI) scores were calculated. Patients were divided into two groups according to their survival status. The nutritional status was evaluated and found to be in accordance with the screening tools. Results: The rate of malnutrition/severe nutrition risk was found to be 28.4%–60%, and the normal nutritional status was 1.7%–33.3%. In-hospital mortality was 41.7%. The duration of stay in ICU (8.0±9.8 days; 20.5±20.0 days, p=0.03), duration of stay in hospital (16.9±14.4 days; 28.5±24.6 days; p=0.029) and mechanical ventilation duration (4.38±6.8 days; 15.56±17.2 days; p=0.01) in patients who survived were shorter than in patients those who died. The male gender, patients with an NRS-2002 score ≥5 and NRI score ≥81.2 had higher mortality rates (respectively, p=0.013, p=0.019, p=0.036). The NRS-2002 was found to have the highest sensitivity; NRI was the highest specificity screening tool. Conclusion: The risk of malnutrition/severe nutrition risk was found to be 28.4%–60%. We found that the male gender, NRS-2002 ≥5, and NRI ≥81.2 were associated with higher mortality. The NRS-2002 was found to have the highest sensitivity; NRI was the highest specificity screening tool. We think that the usage of one screening tool for predicting malnutrition in elderly patients is not sufficient in the diagnosis of malnutrition, and these methods should be evaluated together.

Objective: In this study, seizure-like activity, injection pain, and the presence of dreams after propofol injection were assessed. Material and Method: One hundred women scheduled for obstetric and gynecologic procedures were evaluated. Patients were anesthetized with 1 mg/kg propofol. Seizure-like activity was described as "only left arm. " "started from left arm and involved whole body, " or "face only, " etc. The intensity of seizure-like activity (a brief and involuntary twitching of a muscle or a group of muscles) (SLA) was graded as 0=no SLA, 1=mild SLA -Local Group (only mild fasciculation involving face and/or distal upper and/or lower extremity, focal, or involving a part of the body) and 2=severe SLA -Generalized Group (marked movements involving limbs or trunk, generalized to the whole body). Operation time, additional doses of anesthetic given, time to eye-opening, the presence of dreams, injection-induced pain, and if present, seizure-like activity descriptions were analyzed. Statistical analysis: Baseline characteristics were described with mean, standard deviation, rate, and frequency. The distribution of variables was controlled with Kolmogorov Smirnov test. Quantitative data were compared with ANOVA (Tukey), independent sample t test and Mann Whitney U test. Qualitative data were analyzed using Chi-square test and Fisher test. Statistical analysis was performed using SPSS 21.0 software. A value of p<0.05 was considered significant. Results: The patients in the generalized seizure-like activity group were statistically significantly younger than those in the group with no seizures. Intrinsically, the additional dose in the generalized group was lower than in the group with no seizures and the localized seizure group. In the localized seizure group, there was statistically significant lower injection-induced pain compared to the no-seizure group. Conclusion: Seizure-like activity could be related with the patients' age. Keywords: Seizure-Like Activity, propofol, seizures, GABA, injection induced pain ÖZ Propofol ve epileptiform aktiviteAmaç: Bu çalışmada propofol enjeksiyonunun epileptiform aktivite, enjeksiyon ağrısı, işlem sırasında rüya görmeyle olan ilişkisi incelendi. Gereç ve Yöntem: Obstetrik ve jinekolojik nedenlerle opere olan 100 hasta çalışmaya alındı. Hastalar1 mg/ kg propofol ile uyutuldu. Epileptiform aktivite olup olmadığı, olduğunda, örneğin tek kolda ya da yüzde lokalize olduğu veya tüm vücuda yayıldığı gibi gözlemler not edildi. Bu istemsiz hareketler 0=Yok, 1=Lokalize, 2=Generalize olarak sınıflandırıldı.Operasyon süresi, ilave doz ilaç yapılıp yapılmadığı, göz açma süresi, hastanın işlem sırasında rüya görüp görmediğini hatırlaması, enjeksiyon ağrısı olup olmadığı kaydedildi. İstatistik:Temel değerlendirmede ortalama ve standart sapma kullanıldı.Değişkenlerin dağılımında Kolmogorov Smirnov testi, kantitatif değerlendirmelerde ANOVA (Tukey), independent t test ve Mann Whitney U, kalitatif değerlendirmelerde Ki-kare ve Fisher testi kullanıldı. Bulgular: Generalize epilep...

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Objectives:To compare the combination of paracetamol (20 mg/kg) and propofol to fentanyl (1 µg/kg) and propofol in terms of providing adequate analgesia and a comparable recovery profile in suction termination procedures.Methods:This is a prospective, randomized clinical study in which we obtained informed consents from 146 women (fentanyl group: 76 [52.1%], paracetamol group: 70 [47.9%]) who were scheduled for suction curettage at the Istanbul Kanuni Sultan Suleyman Education and Training Hospital, Istanbul, Turkey in January 2015. Patients were randomly allocated into a fentanyl group or a paracetamol group. Visual analogue scores, modified Aldrete scores, and hemodynamic parameters were recorded during and after the surgical procedure. A record was also maintained of any adverse events.Results:When the modified Aldrete scores at 60 minutes, systolic pressures at 0 minutes, oxygen saturation at 10, 15, 20 minutes, diastolic blood pressure at 10, 15, 20 minutes, heart rates, and visual analogue scores were compared, there was no significant difference between groups (p>0.05). In the fentanyl group, systolic blood pressures at 5, 10, 15, 20 minutes and diastolic blood pressure at 5 minutes and oxygen saturation at 5 minutes were significantly lower (p<0.05).Conclusion:Our study demonstrates that the analgesic properties and recovery profiles of intravenous paracetamol is as effective as fentanyl when used in suction termination procedures. Further larger studies are still required.

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