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Candidemia is a nosocomial infection mostly found in critically ill patients. Our objectives were to evaluate the change in distribution and resistance profile of Candida spp. isolated from candidemic patients in our intensive care unit over two 5-year periods spanning 15 years and to evaluate the risk factors. Records from the microbiology laboratory were obtained, from January 2004 to December 2008 and from January 2013 to December 2017, retrospectively. Antifungal susceptibility was performed by E-test and evaluated according to EUCAST breakpoints. A total of 210 candidemia cases occurred; 238 Candida spp. were isolated in 197 patients (58.8% male; mean age, 59.2 ± 19.6 years). The most predominant risk factor was central venous catheter use. Species distribution rates were 32%, 28%, 17%, and 11% for C. albicans (n = 76), C. parapsilosis (n = 67), C. glabrata (n = 40), and C. tropicalis (n = 27), respectively. Resistance rate to anidulafungin was high in C. parapsilosis over both periods and increased to 73% in the second period. Fluconazole showed a remarkable decrease for susceptibility in C. parapsilosis (94 to 49%). The prevalence of MDR C. parapsilosis (6%/33%) and C. glabrata (0%/44%) increased in the second period. We observed a predominance of non-albicans Candida spp., with C. parapsilosis being the most frequent and C. glabrata infections presenting with the highest mortality. High level of echinocandin resistance in C. parapsilosis and increasing prevalences of MDR C. parapsilosis and C. glabrata seem emerging challenges in our institution.

Background: We aimed to establish an acute treatment protocol to increase serum vitamin D, evaluate the effectiveness of vitamin D3 supplementation, and reveal the potential mechanisms in COVID-19. Methods: We retrospectively analyzed the data of 867 COVID-19 cases. Then, a prospective study was conducted, including 23 healthy individuals and 210 cases. A total of 163 cases had vitamin D supplementation, and 95 were followed for 14 days. Clinical outcomes, routine blood biomarkers, serum levels of vitamin D metabolism, and action mechanism-related parameters were evaluated. Results: Our treatment protocol increased the serum 25OHD levels significantly to above 30 ng/mL within two weeks. COVID-19 cases (no comorbidities, no vitamin D treatment, 25OHD <30 ng/mL) had 1.9-fold increased risk of having hospitalization longer than 8 days compared with the cases with comorbidities and vitamin D treatment. Having vitamin D treatment decreased the mortality rate by 2.14 times. The correlation analysis of specific serum biomarkers with 25OHD indicated that the vitamin D action in COVID-19 might involve regulation of INOS1, IL1B, IFNg, cathelicidin-LL37, and ICAM1. Conclusions: Vitamin D treatment shortened hospital stay and decreased mortality in COVID-19 cases, even in the existence of comorbidities. Vitamin D supplementation is effective on various target parameters; therefore, it is essential for COVID-19 treatment.

Introduction: Reverse transcriptase polymerase chain reaction tests and thoracic tomography have been widely employed in the diagnosis of the disease, but doubts about their sensitivity still persist. Also there are controversial results about ACE2 and AngII levels according to the severity of disease. In this study, we aimed to analyze the ACE2 and AngII levels in patients with suspected COVID-19 based on polymerase chain reaction test results and thoracic tomography findings and to examine their relationship with disease severity. Methodology: Patients with suspected COVID-19 in the emergency department were divided into 4 groups according to thoracic tomography findings and PCR test results. The in-hospital mortality of patients was recorded. ACE2 and AngII levels in patients were analyzed according to groups and severity of the disease. Results: ACE2 levels for the patients with suspected COVID-19 were significantly lower than in the control group, but AngII levels were higher (not statistically significant). The mean age and male sex ratio of patients who developed acute respiratory distress syndrome (ARDS) and died were significantly higher than those who survived. Whereas there was no difference in ACE2 levels in patients with severe diseases such as ARDS and mortality, their AngII levels were significantly lower. Conclusions: It can be suggested that decreased ACE2 levels combined with increased AngII levels are determinative at disease onset and in the development of lung damage. However, decreased AngII levels are more determinative in patients with severe diseases such as ARDS and mortality.

Amaç: Ülkemizde birçok tıp fakültesi ve eğitim-araştırma hastanesinde yoğun bakım yan dal programları açılmıştır ve sahada mezun olan yoğun bakım uzmanları çalışmaktadır. Bu çalışmanın amacı, yoğun bakım yandal uzmanlık eğitiminin durumu ve sahada çalışan yoğun bakım uzmanlarının çalışma koşulları hakkında bilgi toplamaktır. Gereç ve Yöntem: Etik kurul izni alındıktan sonra yoğun bakım yan dal eğiticileri (E), araştırma görevlileri (AG) ve mezun olmuş uzmanlara (U) yönelik üç anket Google Survey aracılığıyla hazırlanarak sosyal medya üzerinden yayınlanmıştır. Anketlerde eğitimin durumu eğitici ve yan dal asistanlarına yöneltilmiş, mezuniyet sonrası sahadaki çalışma koşulları da yan dal uzmanlarına sorulmuştur. Gelen cevaplar için tanımlayıcı istatistik yöntemi kullanılmıştır. Bulgular: Anketler 38 E, 99 AG ve 46 U tarafından cevaplandı. E’lerin %54’ü 51-60 yaşları arasındaydı ve %65,8’i kadındı. E’nin %51’i bir üniversite hastanesinde çalışıyordu. Tam zamanlı E’lerin %47’si tam zamanlı olarak anesteziyoloji ve reanimasyon kliniğinin yoğun bakım bilim dalına bağlı olarak çalışıyorken ve tüm paydaş kliniklerin programa katılım oranı %86,5 idi. E’lerin 27’si (%71,1) TUKMOS temel eğitim programının değiştirilmesi gerektiğini düşünmektedir. AG’nin %54,5’inin ana uzmanlık alanı anesteziyoloji ve reanimasyon olup, %52’si devlet üniversitesinde çalışıyordu. Hastanede nöbet tutanların oranı %87,8, rotasyon eğitimini “orta” olarak tanımlayanların oranı ise %36,5 oldu. Yoğun bakım uzmanlarının %65’i anesteziyoloji ve reanimasyon uzmanı olup, %64,4’ü verimlilik ve kalite açısından öncelikli olarak eğitim ve araştırma hastanelerinde çalışmak istediğini, %87’si yoğun bakım uzmanının herhangi bir yoğun bakım ünitesinde çalışabilmesi gerektiğini belirtmiştir. Yoğun bakım uzmanı olanların %69,6’sı aldıkları eğitimin yeterli olduğunu düşünmektedir. Sonuç: Bu çalışmanın verilerinin değerlendirilmesi ve paylaşılmasının yoğun bakım yandal uzmanlık eğitimi ve mezuniyet sonrası çalışma koşullarında olumlu değişikliklere neden olabileceğine inanıyoruz. Objective: Intensive care subspecialty programs have been opened in many medical faculties and training-research hospitals in our country, and intensivists who have graduated are working in the field. The aim of this study aimed to collect information about the status of intensive care subspecialty education and the working conditions of intensive care specialists working in the field. Materials and Methods: After obtaining the ethics committee approval, three questionnaires for intensive care subspecialty educational staff (ES), research assistants (RA), and graduated specialists (PG) were prepared through the Google Survey and published on social media. In the questionnaires, the status of education and working conditions in the field after graduation were questioned. The descriptive statistics method was used for analysis. Results: The questionnaires were answered by 38 ES, 99 RA, and 46 PG. Fifty-four percent of the ES were between the ages of 51 and 60 and 65.8% were women. Fifty-one percent of ES were working in a university hospital. Forty-seven percent of full-time ES were working in the department of anesthesiology and reanimation subdepartment of intensive care, and the rate of participation of all partner clinics in the program was 86.5%. Twenty-seven (71.1%) of the ES thought that the TUKMOS core training program should be changed. The main specialty of 54.5% of RAs were anesthesiology and reanimation, and 52% of them were studying at a state university. The rate of those who were on duty at the hospital was 87.8%, and the rate of those who described the rotation training as “medium” was 36.5%. Sixty-five percent of the PGs were anesthesiology and reanimation specialists, and 64.4% said that they would like to primarily work in training and research hospitals in terms of efficiency and qualit; 87% of them stated that intensive care specialists should be able to work in any kind of intensive care unit, 69.6% thinks that the education they receive is sufficient. Conclusion: We believe that evaluating and sharing the data of this study may cause positive changes in intensive care subspecialty education and post-graduate working conditions.

Prone position (PP) is a recommended intervention in severe classical acute respiratory distress syndrome (ARDS). Changes in lung resting volume, respiratory mechanics and gas exchange during a 16-h cycle of PP in COVID-19 ARDS has not been yet elucidated. Patients with severe COVID-19 ARDS were enrolled between May and September 2021 in a prospective cohort study in a University Teaching Hospital. Lung resting volume was quantitatively assessed by multiple breath nitrogen wash-in/wash-out technique to measure the end-expiratory lung volume (EELV). Timepoints included the following: Baseline, Supine Position (S1); start of PP (P0), and every 4-h (P4; P8; P12) until the end of PP (P16); and Supine Position (S2). Respiratory mechanics and gas exchange were assessed at each timepoint. 40 mechanically ventilated patients were included. EELV/predicted body weight (PBW) increased significantly over time. The highest increase was observed at P4. The highest absolute EELV/PBW values were observed at the end of the PP (P16 vs S1; median 33.5 ml/kg [InterQuartileRange, 28.2-38.7] vs 23.4 ml/kg [18.5-26.4], < 0.001). Strain decreased immediately after PP and remained stable between P4 and P16. PaO /FiO increased during PP reaching the highest level at P12 (P12 vs S1; 163 [138-217] vs 81 [65-97], < 0.001). EELV/PBW, strain and PaO /FiO decreased at S2 although EELV/PBW and PaO /FiO were still significantly higher as compared to S1. Both absolute values over time and changes of strain and PaO /FiO at P16 and S2 versus S1 were strongly associated with EELV/PBW levels. In severe COVID-19 ARDS, EELV steadily increased over a 16-h cycle of PP peaking at P16. Strain gradually decreased, and oxygenation improved over time. Changes in strain and oxygenation at the end of PP and back to SP were strongly associated with changes in EELV/PBW. Whether the change in EELV and oxygenation during PP may play a role on outcomes in COVID-ARDS deserves further investigation. [www.ClinicalTrials.gov], identifier [NCT04818164].

Objective: Sedation is one of the most common practices applied in the intensive care units (ICUs), and the management of sedation, analgesia and delirium is a quality measure in the ICUs. Several guidelines on sedation had been published, and many surveys investigated the practices of sedation in the ICUs, but knowledge on the sedation practices in Turkey is lacking. The aim of the present study was to provide baseline knowledge on the sedation practices and preferences of Turkish intensive care physicians and to establish some points to be improved. Methods: An electronic survey form consisting of 34 questions was generated and posted to email addresses. The survey included questions about demographics and practices on sedation, analgesia, neuromuscular blockage and delirium. Results: Of 1700 email addresses, 429 (25.0%) were returned. Sedation was practised by 98.0% of the respondents, and mechanical ventilation was indicated as the primary indication (94.0%) for sedation. The presence of a written sedation protocol was 37.0%. For drug choices for sedation, midazolam was the most preferred agent (90.0%). With regard to pain questions, the most commonly used evaluation tool was Visual Analogue Scale (69.0%), and the most preferred drug was tramadol. Nearly half of the participants routinely evaluated delirium and used the confusion assessment method in the ICU. Conclusion: The results of this survey have indicated some areas to be improved, and a national guideline should be prepared taking pain, agitation and delirium in focus. ClinicalTrials.gov ID: NCT03488069.

Candida parapsilosis is a normal saprophyte of the skin and is characterized by the affinity for central venous catheters. Over the past decade, reports indicate that Candida parapsilosis is often the second most commonly isolated Candida species from blood cultures. This species has significantly lower sensitivity in vitro to echinocandins than other Candida species. In this paper, we have presented a case of Candida parapsilosis catheter-related sepsis in a patient with chronic renal failure. (JAREM 2014; 2: 82-4)

Background: To assess the treatment and outcome of patients with crush injury sustained in the Marmara earthquake. Methods: Seven hundred eighty three patients were transferred to a university hospital and 25 of them were admitted to the intensive care unit. The medical records of 18 crush injury patients were retrospectively reviewed. Results: The major associated injuries were in the lower extremities, upper extremities, and chest. Seven patients underwent fasciotomy and six patients had amputations. Twelve patients required mechanical ventilation. Adult respiratory distress syndrome developed in four patients. Oliguria occurred in eight patients. Hyperkalaemia was seen in six patients and four of them underwent emergency haemodialysis. One patient died because of hyperkalaemia on arrival to the intensive care unit. Renal failure was treated with haemodialysis or haemoperfusion in 13 patients. Five patients died because of multiple organ failure and two patients because of sepsis. Conclusion: Crush syndrome is a life treatening event. The authors believe that early transportation and immediate intensive care therapy would have improved the survival rate.