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Introduction: Nephrotoxicity is the most important adverse effect of colistin therapy. We investigated the frequency of nephrotoxicity, risk factors related to nephrotoxicity, and its relationship with mortality in patients who received intravenous colistin in intensive care units (ICUs). Materials and methods: We retrospectively reviewed the data of patients who received intravenous colistin in ICUs between 2011 and 2017. Acute kidney injury (AKI) diagnosis and staging were made based on the Kidney Disease Improving Global Outcome criteria. Results: There were 149 patients included in the study with 61% being male. The mean age was 58.7 ± 20.3 years. AKI was detected in 96 (64.4%) patients. There were 25 patients with AKI stage 1 (16.8%) and 71 patients with AKI stage 2 or 3 (47.7%). Advanced age (65.0 vs. 47.4 years; p < .001), diabetes mellitus (p < .001), heart failure (p ¼ .01), high APACHE II score (31.7 vs. 28.08, p ¼ .019), and inotrope usage (p ¼ .01) were found as risk factors for AKI. The 14-day mortality rate was higher in the AKI group (p ¼ .027). Discussion: Higher AKI and mortality rates are observed in patients with diabetes, heart failure, advanced age and the hemodynamically impaired. However, it is a fact that there are no alternative therapies other than colistin in the treatment of multidrug-resistant Gram-negative bacterial infections. Therefore, the development of AKI in this patient group should not be considered a sufficient reason for discontinuing colistin treatment. Understanding the risk factors in this potential nephrotoxic treatment can provide a more careful patient follow-up.

Background and PurposeVitamin A is depleted during infections. Vitamin A has been used successfully in measles, RSV and AIDS patients and is an effective vaccine adjuvant. In this study, low retinol levels were found in patients with severe COVID-19. Retinoid signaling impairment in COVID-19 disrupts Type-I interferon synthesis.Material and MethodTwo groups were formed in the study. The patient group consisted of 27 (Group 1) severe COVID-19 patients hospitalized in the intensive care unit with respiratory failure, and the control group consisted of 23 (Group 2) patients without COVID-19 symptoms. Serum retinol levels were analyzed by ELIZA and HPLC in both groups.FindingsRetinol levels were found to be significantly lower in the patient group (P <0.001). There was no difference in retinol between two different age groups in the patient group (P> 0.05). There was no significant difference in retinol between men and women (P> 0.05). Comorbidity did not affect serum retinol levels (P >0.05).ConclusionSerum retinol levels were low in patients with severe COVID-19. Drugs preventing retinol excretion were not stopped in the patient group. Some patients took vitamin A externally. Despite this, retinol was low in COVID-19 patients. Retinol depletion impairs Type-I interferon synthesis by impairing retinoid signaling. Retinoid signaling may be the main pathogenetic disorder in COVID-19. This pathogenesis can serve as a guide for adjuvants, drug targets, and candidate drugs. Retinol, retinoic acid derivatives, and some CYP450 inhibitors may work on COVID-19.

Background: In studies, ABO blood group system has been shown to be associated with type 2 diabetes mellitus, chronic renal failure, gestational diabetes mellitus, postpartum depression, coronary artery disease, Crohn’s disease as well as various cancer types such as stomach, breast, skin cancers and rheumatologic diseases. Aims and Objective: The relationship between anti TPO positivity and ABO blood group system is aimed to be investigated by using blood groups which are the product of genetic structure and easy to identify by considering the relationship between anti TPO positivity and blood group. Materials and Methods: 4312 patients with determined blood groups were included among the patients, who were admitted to the internal medicine outpatient clinics of our hospital between January 2, 2017 and May 28, 2019 and were screeened for thyroid antibodies with thyroiditis susceptibility. Results: The most common blood group was A in both anti TPO positive and anti TPO negative patient groups.The rate of those with O blood group was 2.65% higher in anti TPO positive group than anti TPO negative group. B blood group was found to be 4.87% higher in anti TPO negative group than anti TPO positive group (p:0.148). Conclusion: In conclusion, it was found that O blood group may be a risk factor for anti TPO positivity and B blood group is much lower in anti TPO positive ones. However, it is obvious that more comprehensive prospective multicentered clinical and experimental studies are needed to establish the relationship between blood groups and autoimmune diseases, especially autoimmune thyroiditis.

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ÖZETAmaç: Akut intoksikasyonlar; özkıyım amaçlı veya bilinçsiz şekilde yüksek doz ilaç kullanma şeklinde olabilen önemli bir halk sağlığı sorunudur. Çalışmamızda akut intoksikasyon nedeniyle yoğun bakım ünitesinde (YBÜ) takip edilen hastaların demografik ve klinik verilerini retrospektif olarak incelemeyi amaçladık. Sonuç: Akut intoksikasyonların; büyük oranda genç kadın hastalarda, intihar amaçlı ve mevsim olarak yaz aylarında olduğunu saptadık. Analjezik ilaçların zehirlenme amacıyla en sık kullanılan ilaç olduğunu belirledik. Gereç veAnahtar Kelimeler: İntoksikasyon, yoğun bakım ünitesi, retrospektif ABSTRACT Objective: Acute intoxication is an important public health problem that occur result of suicide cases or unintentionally drug overdose. We aimed to retrospectively review the demographic and clinical data of the patients who were followed up in intensive care unit due to acute intoxication. Materials and Methods:We retrospectively reviewed the files of all 152 patients who were admitted to intensive care unit between January 2014-January 2016 due to acute intoxication. A two-sided P value <0.05 was considered significant for all analyses. Continuous variables were presented as mean ± standard deviation. Results:The 118 of 152 patients were female, 34 were male. Female to male ratio was 3.4/1. Mean age was 26.2±11.16 years. The mean length of stay in the intensive care unit was 1.85±1.05 days. The 118 of 152 (%77.6) patients were under 30 years old. The rate of intoxications were statistically lower in male than females under 30 years old. (p<0.05) Suicidal attempt was found in 145 patients (%95.32). The majority of medicine drug use was in suicide cases (%90.7). The most frequent medicine drugs were analgesics (%36.8), psychoactive drugs (%23) and antimicrobials (%19.7). %42.1 of cases were intoxicated with one drug, %48.02 of cases were intoxicated with multiple drugs. There was only one death due to pepticide poisoning. The rate of seasonal distribution of intoxications were spring (44%). The mean time to ICU admission was 292.93±201.75 minutes. Conclusion:Acute intoxications were mostly seen in especially female young female adults and the most common was suicidal attempt by medicine drugs. The most common used drugs for poisoning were analgesics.

Diyabetik otonom nöropati, diyabetin en sık ve en sıkıntı verici komplikasyonudur. Otonom sinir sistemi (OSS) tutulumu genellikle diffuz olsa da, semptomlar tek bir hedef organ veya sistem ile sınırlı olabilir.Diyabetik otonom nöropatinin komplikasyonları mortalite ve morbiditede artışa, yaşam kalitesinde azalmaya ve diyabetik hastaların tedavi maliyetinde artışa sebep olmaktadır.Bu komplikasyonların patogenezindeki faktörler; metabolizmada değişme, vasküler yetersizlik, büyüme faktörlerinin trofizminde kayıp ve viseral ve kutanöz sinirlerde otoimmun destriksiyon olarak sıralanabilir. Diyabetik otonom nöropatinin komplikasyonları ve klinik manifestasyonları ile ilgili yayınlar mevcuttur. Gelecekte, hastalığın altında yatan patolojik sürecin daha iyi anlaşılması ile birlikte, tedaviler manifestasyona değil neden yönelik olabilir. Halen sürmekte olan ve otonom sinirlerin rejenerasyonunun indüklenebilir olduğu bir takım çalışmaların varlığı, diyabetik otonom nöropati hastalarının tedavisinde ümit vericidir. AbstractDiabetic autonomic neuropathy is the most common and troublesome complication of diabetes mellitus. Though involvement of the autonomic nervous system is generally diffuse, symptoms may be confined to a single target organ or organ system. Complications of diabetic autonomic neuropathy contribute greatly to the morbidity, mortality, and reduced quality of life of the person with diabetes and are the major source of increased costs of caring for the diabetic patient. Factors in the pathogenesis of these complications are altered metabolism, vascular insufficiency, loss of growth factor trophism, and autoimmune destruction of nerves in a visceral and cutaneous distribution. The clinical manifestations and the complications of diabetic autonomic neuropathy are reviewed. Future therapeutic strategies that are developed from a better understanding of the pathogenetic processes underlying this disorder can be directed at the cause rather than the manifestations. There are studies in progress that suggest that autonomic nerves can be induced to regenerate, and the future for patients with diabetic autonomic neuropathy is brighter.