AIm: Our research was focused on the neuroprotective function of erythropoietin (Epo) in patients with severe closed traumatic brain injury (TBI). mATeRIAL and meTHods: Our model examined the influence of the outcome and neurological recovery in 42 adults with TBI who were admitted to ICU within 6 hours of their injury and were recruited into a randomized controlled study of two groups; only the patients of the intervention group received 10,000 i.u. of Epo for 7 consecutive days. A prognostic model based on CRASH II injury model and outcome was measured by survival and Glasgow Outcome Scale-Extended version (GOS-E) score at 6 months post-injury.ResuLTs: Six patients (18.7%) died during the first two weeks; 4 of the control group and 2 of the intervention group. A mortality rate of 22.2% and 8.3% for the control and intervention group respectively was observed. A lower rate of good outcome (GOS-E score > 4) at 6 months was mentioned among patients of the control group. CoNCLusIoN:The study provides evidence of lower mortality and better neurological outcome for the patients who received Epo increasing the possibility that Epo therapy could be used in clinical practice, limiting neuronal damage induced by TBI.KeywoRds: Brain, Injury, Erythropoietin, Mortality, Outcome ÖZ AmAÇ: Araştırmamız, şiddetli kapalı travmatik beyin yaralanması (TBY) olan hastalarda eritropoietinin (Epo) nöroprotektif işlevi üzerine odaklanmıştı. yÖNTem ve GeReÇLeR: Modelimiz, yaralanmadan sonra 6 saat içinde yoğun bakıma gelen ve iki grup halinde randomize kontrollü bir çalışmaya kaydedilen 42 yetişkinde sonuç ve nörolojik iyileşme üzerine etkiyi inceledi; sadece girişim grubundaki hastalara arka arkaya 7 gün boyunca 10.000 i.u. Epo uygulandı. Yaralanmadan 6 ay sonra CRASH II yaralanma modeli temelinde prognostik bir model kullanıldı ve sonuç sağkalım ve Glasgow Sonuç Ölçeği-Genişletilmiş versiyon (GOS-E) puanıyla ölçüldü.BuLGuLAR: İlk iki haftada kontrol grubunda 4 ve girişim grubunda 2 hasta olarak altı hasta (%18,7) öldü. Kontrol ve girişim grupları için sırasıyla %22,2 ve %8,3 mortalite oranı gözlendi. Kontrol grubunda 6 ayda daha düşük bir iyi sonuç oranı (GOS-E puanı > 4) görüldü.soNuÇ: Çalışma, Epo alan hastalarda daha düşük mortalite ve daha iyi nörolojik sonuç bulguları vermiştir ve böylece Epo tedavisinin klinik uygulamada kullanılıp TBY nedeniyle oluşan nörolojik hasarı sınırlaması olasılığını ortaya koymuştur.
This study shows that sAlb levels might change during the first days after an acute IS, but these changes although statistically significant are not clinically significant if we take into account the analytical and biological variation of sAlb.
Objective. We evaluated whether routine ultrasound examination may illustrate gallbladder abnormalities, including acute acalculous cholecystitis (AAC) in the intensive care unit (ICU). Patients and Methods. Ultrasound monitoring of the GB was performed by two blinded radiologists in mechanically ventilated patients irrespective of clinical and laboratory findings. We evaluated major (gallbladder wall thickening and edema, sonographic Murphy's sign, pericholecystic fluid) and minor (gallbladder distention and sludge) ultrasound criteria. Measurements and Results. We included 53 patients (42 males; mean age 57.6 ± 2.8 years; APACHE II score 21.3 ± 0.9; mean ICU stay 35.9 ± 4.8 days). Twenty-five patients (47.2%) exhibited at least one abnormal imaging finding, while only six out of them had hepatic dysfunction. No correlation existed between liver biochemistry and ultrasound results in the total population. Three male patients (5.7%), on the grounds of unexplained sepsis, were diagnosed with AAC as incited by ultrasound, and surgical intervention was lifesaving. Patients who exhibited ≥2 ultrasound findings (30.2%) were managed successfully under the guidance of evolving ultrasound, clinical, and laboratory findings. Conclusions. Ultrasound gallbladder monitoring guided lifesaving surgical treatment in 3 cases of AAC; however, its routine application is questionable and still entails high levels of clinical suspicion.
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