Browsing by Author "Kahveci, Ferda"

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Amitriptyline cardiac toxicity treated with hemoperfusion
(Galenos Yayincilik, 2017-04-01) Girgin, Nermin Kelebek; KELEBEK GİRGİN, NERMİN; Ünlü, Nurdan; Çalışkan, Gülbahar; İşçimen, Remzi; İŞÇİMEN, REMZİ; Kahveci, Ferda; KAHVECİ, FERDA ŞÖHRET; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Anestezi ve Reanimasyon Anabilim Dalı.; AAH-7250-2019; HKP-2533-2023; KFQ-1825-2024
Tricyclic antidepressant intoxication is frequently encountered among children and adults due to widespread use of the drugs. Amitriptyline is among the major tricyclic antidepressants. It affects the cardiovascular, respiratory and central nervous system. In the treatment of amitriptyline intoxication, various treatments such as gastric lavage, activated charcoal, bicarbonate infusion, antiarrhythmic, and anticonvulsant drug usage were applied. Here, we reported a patient with severe amitriptyline intoxication who did not respond to these treatments but dramatically improved with hemoperfusion. A 33 year-old woman applied to the emergency service half an hour later ingesting 2000 mg of amitriptyline as a suicide attempt. On admission, her Glasgow coma scale (GCS) was 10, blood pressure was 100/60 mmHg, heart rate was 160 beats/min. Wide ORS and ventricular tachycardia was seen in the Electrocardiography (ECG) results. Having her GCS regressed to 7, she was intubated and admitted to intensive care unit after the initial treatments. Hemoperfusion was commenced within half an hour. While hemoperfusion was continuing, her ECG was seen to turn to sinus tachycardia. Her cardiovascular and neurological status returned to normal on the 2nd day and she was discharged from the intensive care unit on the 4th day. Besides hemoperfusion is not recommended due to high protein binding and large volume of distribution in classical treatment of amitriptyline overdose, current reports representing efficacy of hemoperfusion are also accumulating. After ingestion, tricyclic antidepressants are absorbed rapidly and reach to their effective concentration in the tissues, especially by the lung, the brain and the heart. Hence, hemoperfusion performed in early stage of ingestion is an effective treatment and in cases that do not respond to conventional therapies, it should be considered that this method can be used in the early period.
Analysis of acute adult poisoning cases among patients admitted to the emergency department in Bursa, Turkey
(Galenos Yayınevi, 2009-01-01) Demircan, Celaleddin; Kahveci, Ferda; Engindeniz, Zülfi; Kıyıcı, Murat; Girgin, Nermin Kelebek; Ercan, İlker; Tekce, Hikmet; Özdemir, Fatma; Özyurt, Gurayten; DEMİRCAN, CELALEDDİN; KAHVECİ, FERDA ŞÖHRET; Engindeniz, Zülfi; KIYICI, MURAT; KELEBEK GİRGİN, NERMİN; ERCAN, İLKER; Tekce, Hikmet; ÖZDEMİR, FATMA; Özyurt, Gurayten; Uludağ Üniversitesi/Tıp Fakültesi/Dahili Tıp Bilimleri Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Anesteziyoloji ve Reanimasyon Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Acil Tıp Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Gastroenteroloji ve Hepatoloji Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Biyoistatistik Anabilim Dalı.; 0000-0003-4820-2288; 0000-0003-1874-5097; 0000-0002-3208-6211; 0000-0002-2382-290X; HJZ-4470-2023; AAG-9356-2021; JBJ-5787-2023; AAI-4213-2021; AAH-7250-2019; ABF-2367-2020; JGP-4019-2023; JKS-7683-2023; JKO-9428-2023
Purpose: The aim of this study was to define the epidemiological features such as age, sex, toxic substance, suicide, and mortality rates of the adult poisoning cases among patients admitted to the Emergency Department (ED) of Uludag University Medical Faculty Hospital.Materials and Methods: Records of acute adult poisoning cases at the ED within a one-year period (June 1, 2002 - May 31, 2003) were evaluated retrospectively. Data were compared to those of similar studies from Turkey and around the world.Results: In total 430 (1.96%) of 21,934 patients admitted to the ED during the study period suffered acute poisoning. Of these patients 259 (60.2%) were women and 171 (39.8%) were men and the mean age of the patients was 29.9. Patients were exposed to different types of toxic substances: drugs (47.4%), pesticides (10.7%), toxic gases (10%), corrosives (6.5%), alcohol (3.5%), food (15.8%), toxic substances of animal origin (3.0%), and others (3.0%). In all, 29.8% of the patients were admitted to hospital, 22.3% were transferred to other hospitals, and 47.9% were discharged from the ED, and the overall mortality rate was 1.2%. In addition, 54.9% of the poisonings were suicide attempts and within this group the women to men ratio was 2.2 and the most common toxic substance was a drug (85.2%).Conclusion: Our results were similar to those of previous studies from this country as acute poisonings are more common in women and younger ages, most of them were suicide attempts, and the mortality rate was low. Our transfer rate was high and this may necessitate the organization of short-term observation of these patients.
Comparison of blood culture and multiplex real-time PCR for the diagnosis of nosocomial sepsis
(Edizioni Minerva Medica, 2016-03) Dinç, Fatih; Akalın, Halis; Özakın, Cüneyt; Sınırtaş, Melda; Kebabçı, Nesrin; İşçimen, Remzi; Girgin, Nermin Kelebek; Kahveci, Ferda; Uludağ Üniversitesi/Tıp Fakültesi/Mikrobiyoloji ve Klinik Mikrobiyoloji Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Enfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Anesteziyoloji ve Reanimasyon Anabilim Dalı.; 0000-0001-8111-5958; 0000-0001-5428-3630; 0000-0003-4820-2288; AAI-8104-2021; AAG-8392-2021; AAU-8952-2020; AAG-9356-2021; 57193412784; 57207553671; 57200678942; 6505818048; 56060994000; 16645821200; 55663009300; 6602405968
BACKGROUND: In many cases of suspected sepsis, causative microorganisms cannot be isolated. Multiplex real-time PCR generates results more rapidly than conventional blood culture systems. METHODS: In this study, we evaluated the diagnostic performance of multiplex real-time PCR (LightCycler (R) SeptiFast, Roche, Mannheim, Germany), and compared with blood cultures and cultures from focus of infection in nosocomial sepsis. RESULTS: Seventy-eight nosocomial sepsis episodes in 67 adult patients were included in this study. The rates of microorganism detection by blood culture and PCR were 34.2% and 47.9%, respectively. Sixty-five microorganisms were detected by both methods from 78 sepsis episodes. Nineteen of these microorganisms were detected by both blood culture and PCR analysis from the same sepsis episode. There was statistically moderate concordance between the two methods (kappa=0.445, P<0.001). There was no significant agreement between the blood culture and PCR analysis in terms of microorganism detected (kappa=0.160, P=0.07). Comparison of the results of PCR and cultures from focus of infection revealed no significant agreement (kappa=0.110, P=0.176). However, comparison of the results of PCR and blood cultures plus cultures from focus of infection ( positive blood culture and/or positive culture from focus of infection) showed poor agreement (kappa=0.17, P=0.026). When the blood culture was used as the gold standard, the sensitivity, specificity, positive and negative predictive value of PCR in patients with bacteremia was 80%, 69%, 57% and 87%, respectively. CONCLUSIONS: SeptiFast may be useful when added to blood culture in the diagnosis and management of sepsis.
Cuffed oropharyngeal airway as a suitable alternative to the laryngeal mask airway for minor outpatient surgery
(Lippincott Williams & Wilkins, 2002-03) Acar, H. Volkan; Yavaşçaoğlu, Belgin; Kahveci, Ferda; Kaya, Fatmanur Nazlı Dinçer; Özcan, Bahar; Uludağ Üniversitesi/Tıp Fakültesi/Anesteziyoloji Anabilim Dalı.; AAI-7914-2021; AAG-9356-2021; AAI-8213-2021; 6602742300; 6602405968; 7003619647; 6603825848
Background and objective: To compare the application of the cuffed oropharyngeal airway and the laryngeal mask airway on anaesthetized adult patients undergoing minor outpatient surgery. Methods: One hundred patients received intravenous fentanyl, propofol and N2O for the induction and maintenance of anaesthesia. The patients were randomly divided into two groups: a cuffed oropharyngeal airway group (n = 50) and a laryngeal mask airway group (n = 50). After insertion of the device, fibreoptic laryngoscopy was attempted and the degree of success scored. We then compared the first application success rate of both procedures while judging airway intervention requirement, fibreoptic scores, adverse airway events and haemodynamic tolerance. Results: Both devices had an almost similar first-time placement rate (cuffed oropharyngeal airway 84% versus laryngeal mask airway 96%). The cuffed oropharyngeal airway required a higher number of airway interventions (P < 0.001). The laryngeal mask airway had a significantly better fibreoptic view compared with the cuffed oropharyngeal airway (P < 0.001). However, the number of adverse airway events was lower in the cuffed oropharyngeal airway group; there were no significant differences in adverse events and haemodynamic variables between the said two groups. Conclusions: The results suggest that the cuffed oropharyngeal airway was an effective alternative airway in spontaneously breathing patients during short procedures.
Efficacy of antiseptic-impregnated catheters on catheter colonization and catheter-related bloodstream infections in patients in an intensive care unit
(W. B. Saunders, 2006) Osma, Selcan; Kahveci, Ferda; Kaya, Fatma Nur; Akalın, Halis; Özakın, Cüneyt; Yılmaz, Emel; Kutlay, Oya; Uludağ Üniversitesi/Tıp Fakültesi/Mikrobiyoloji ve Enfeksiyon Hastalıkları Anabilim.; Uludağ Üniversitesi/Tıp Fakültesi/Anesteziyoloji Anabilim Dalı.; 0000-0003-4820-2288; AAI-8213-2021; AAG-9356-2021
This study was conducted to evaluate the impact of central venous catheters impregnated with chlorhexidine and silver sulphadiazine on the incidence of colonization and catheter-related bloodstream infection in critically ill patients. One hundred and thirty-three patients requiring central venous catheterization were chosen at random to receive either an antiseptic-impregnated triple-lumen catheter (N = 64) or a standard triple-lumen catheter (N = 69). The mean (SD) durations of catheterization for the antiseptic and standard catheters were 11.7 (5.8) days (median 10; range 3-29) and 8.9 (4.6) days (median 8.0; range 3-20), respectively (P = 0.006). Fourteen (21.9%) of the antiseptic catheters and 14 (20.3%) of the standard catheters had been colonized at the time of removal. (P = 0.834). Four cases (6.3%) of catheter-related bloodstream infection were associated with antiseptic catheters and one case (1.4%) was associated with a standard catheter (P = 0.195). The catheter colonization rates were 18.7/1000 catheter-days for the antiseptic catheter group and 22.6/1000 catheter-days for the standard catheter group (P = 0.640). The catheter-related bloodstream infection rates were 5.3/1000 catheter-days for the antiseptic catheter group and 1.6/1000 catheter-days for the standard catheter group (P = 0.452). In conclusion, our results indicate that the use of antiseptic-impregnated central venous catheters has no effect on the incidence of either catheter colonization or catheter-related bloodstream infection in critically ill patients.
Epidemiology of intra-abdominal infection and sepsis in critically ill patients: "AbSeS", a multinational observational cohort study and ESICM Trials Group Project
(Springer, 2019-10-09) Ünlü, Nurdan; Kahveci, Ferda; CYR-2043-2022; CHB-0826-2022; 56646135200
Purpose To describe the epidemiology of intra-abdominal infection in an international cohort of ICU patients according to a new system that classifies cases according to setting of infection acquisition (community-acquired, early onset hospital-acquired, and late-onset hospital-acquired), anatomical disruption (absent or present with localized or diffuse peritonitis), and severity of disease expression (infection, sepsis, and septic shock).MethodsWe performed a multicenter (n=309), observational, epidemiological study including adult ICU patients diagnosed with intra-abdominal infection. Risk factors for mortality were assessed by logistic regression analysis.ResultsThe cohort included 2621 patients. Setting of infection acquisition was community-acquired in 31.6%, early onset hospital-acquired in 25%, and late-onset hospital-acquired in 43.4% of patients. Overall prevalence of antimicrobial resistance was 26.3% and difficult-to-treat resistant Gram-negative bacteria 4.3%, with great variation according to geographic region. No difference in prevalence of antimicrobial resistance was observed according to setting of infection acquisition. Overall mortality was 29.1%. Independent risk factors for mortality included late-onset hospital-acquired infection, diffuse peritonitis, sepsis, septic shock, older age, malnutrition, liver failure, congestive heart failure, antimicrobial resistance (either methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, extended-spectrum beta-lactamase-producing Gram-negative bacteria, or carbapenem-resistant Gram-negative bacteria) and source control failure evidenced by either the need for surgical revision or persistent inflammation.ConclusionThis multinational, heterogeneous cohort of ICU patients with intra-abdominal infection revealed that setting of infection acquisition, anatomical disruption, and severity of disease expression are disease-specific phenotypic characteristics associated with outcome, irrespective of the type of infection. Antimicrobial resistance is equally common in community-acquired as in hospital-acquired infection.
Epidemiology of sepsis in intensive care units in Turkey: A multicenter, point-prevalence study
(BioMed Central, 2018-03-12) Baykara, Nur; Arslantas, Mustafa Kemal; Hancı, Volkan; Çağlayan, Çiğdem; Demirağ, Kubilay; Baydemir, Canan; Ünal, Necmettin; Akalın, Halis; Kahveci, Ferda; Uludağ Üniversitesi/Tıp Fakültesi/Enfeksiyon Hastalıkları Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Anesteziyoloji Anabilim Dalı/Yoğun Bakım Bilim Dalı.; 0000-0003-4820-2288; AAU-8952-2020; CYR-2043-2022; 57207553671; 6602405968
Background: The prevalence and mortality of sepsis are largely unknown in Turkey, a country with high antibiotic resistance. A national, multicenter, point-prevalence study was conducted to determine the prevalence, causative microorganisms, and outcome of sepsis in intensive care units (ICUs) in Turkey. Methods: A total of 132 ICUs from 94 hospitals participated. All patients (aged > 18 years) present at the participating ICUs or admitted for any duration within a 24-h period (08:00 on January 27, 2016 to 08:00 on January 28, 2016) were included. The presence of systemic inflammatory response syndrome (SIRS), severe sepsis, and septic shock were assessed and documented based on the consensus criteria of the American College of Chest Physicians and Society of Critical Care Medicine (SEPSIS-I) in infected patients. Patients with septic shock were also assessed using the SEPSIS-III definitions. Data regarding demographics, illness severity, comorbidities, microbiology, therapies, length of stay, and outcomes (dead/alive during 30 days) were recorded. Results: Of the 1499 patients included in the analysis, 237 (15.8%) had infection without SIRS, 163 (10.8%) had infection with SIRS, 260 (17.3%) had severe sepsis without shock, and 203 (13.5%) had septic shock. The mortality rates were higher in patients with severe sepsis (55.7%) and septic shock (70.4%) than those with infection alone (24.8%) and infection + SIRS (31.2%) (p < 0.001). According to SEPSIS-III, 104 (6.9%) patients had septic shock (mortality rate, 75.9%). The respiratory system (71.6%) was the most common site of infection, and Acinetobacter spp. (33.7%) were the most common isolated pathogen. Approximately, 74.9%, 39.1%, and 26.5% of Acinetobacter, Klebsiella, and Pseudomonas spp. isolates, respectively, were carbapenem-resistant, which was not associated with a higher mortality risk. Age, acute physiology and chronic health evaluation II score at ICU admission, sequential organ failure assessment score on study day, solid organ malignancy, presence of severe sepsis or shock, Candida spp. infection, renal replacement treatment, and a nurse-to-patient ratio of 1: 4 (compared with a nurse-to-patient ratio of 1:2) were independent predictors of mortality in infected patients. Conclusions: A high prevalence of sepsis and an unacceptably high mortality rate were observed in Turkish ICUs. Although the prevalence of carbapenem resistance was high in Turkish ICUs, it was not associated with a higher risk for mortality.
Erişkin yoğun bakım ünitesinde perkütan gastrostomi uygulamaları: Retrospektif bir analiz
(Bursa Uludağ Üniversitesi, 2021) Alnawajha, Abeldalazeze; Kahveci, Ferda; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Anesteziyoloji ve Reanimasyon Anabilim Dalı.
Amaç: Perkütan Endoskopik Gastrostomi (PEG), yetersiz oral alım nedeniyle beslenme ihtiyaçlarını karşılayamayan, fonksiyonel olarak normal gastrointestinal sistem hastalarına etkili bir enteral beslenme yöntemidir. Çalışmamızın amacı, yoğun bakımımızda enteral bir yol olarak PEG deneyimimizi bir araya getirmek ve PEG endikasyonlarımızı ve komplikasyonlarımızı literatür ile karşılaştırmaktır. Yöntem: Bursa Uludağ Üniversitesi Yoğun Bakım Ünitemizde 1 Ocak 2014 - 30 Haziran 2019 tarihleri arasında PEG'nin sonucu ve komplikasyonları retrospektif olarak değerlendirildi. Bulgular: 68 hasta (23 erkek, 45 kadın) çalışmamıza dahil edildi. Ortalama yaş 57.6 ± 19.9 olarak saptandı. PEG için en yaygın endikasyonlar; Travmatik Beyin Hasarı (19/68, % 27.9), Serebrovasküler Hastalık (16/68, % 23.5) ve İskemik Ensefalopati (17/68, % 25) idi. 61 hasta (% 89.7) Nazogastrik Tüp ile enteral yolu ile, 6 hasta (% 8.8) parenteral yolu ile, 1 hasta (% 1.5) her iki yoldan beslenmişti. Ortalama hastanede kalış süresi 94,5 ± 64,3 gündü, yatışın ortalama 45.6±30.1 gününde PEG açılmıştı. 8 hastaya (% 11.8) profilaktik olarak 1 doz antibiyotik uygulanmıştı, 27 hasta (% 39.2) devam eden enfeksiyonlar nedeniyle antibiyotik kullanıyordu, 33 hasta (% 48.5) antibiyotik kullanımı yoktu. PEG açıldıktan ortalama 13.5±12.4 saat (3-72 saat) sonra beslenmeye başlanmıştı. 5 hastada işleme bağlı komplikasyonlar görülmüş, 3 hastada (% 4.4) çoklu girişimler, bir hastada (% 1.5) klinik olarak anlamlı olmayan mikroperforasyon ve bir hastada (% 1.5) mide perforasyonu görülmüş, bu hasta beslenme başladıktan hemen sonra genel durumu bozulmuş, vasopresör ihtiyacı olmuş, antibiyotik başlanmış, genel cerrahi tarafından ameliyat edilmiş, tam iyileşme sağlanmıştı. Minör komplikasyon toplamda 11 hastada (% 13.2) görülmüş, 5 hastada (% 7.4) giriş noktası çevresinde sızıntı, 3 hastada (% 4.4) giriş çevresinde enfeksiyon, 1 hastada (% 1.5) tüp yerinden çıkma, 1 hastada tüpte yırtık (% 1.5), 1 hastada (% 1.5) tüp tıkanıklığı görülmüştü. 5 hastada majör komplikasyon, 2 hastada (% 2.9) selülit, 2 hastada (% 2.9) pulmoner aspirasyon, antiplatelet tedavi alan bir iii hastada (% 1.5) müdahale gerektiren hematom görülmüştü. Toplamda12 hasta (% 17.6) PEG ile ilişkili olmayan altta yatan hastalıklar nedeniyle exitus olmuştu. Sonuç: Uzman ellerde PEG, enteral beslenme için güvenli ve etkili bir beslenme yöntemidir, Perforasyon gibi ciddi komplikasyonlarda, işlem sonrası hastaların yakın takibi ve şüphe durumunda hızlı davranılması ölümleri önleyebilir.
Evaluation of a clinical pulmonary infection score in the diagnosis of ventilator-associated pneumonia
(Mre Press, 2012-04) Güler, Emre; Kahveci, Ferda; Akalın, Halis; Sınırtaş, Melda; Bayram, Sami; Özcan, Berin; Uludağ Üniversitesi/Tıp Fakültesi/Anesteziyoloji ve Reanimasyon Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Mikrobiyoloji ve Enfeksiyon Hastalıkları Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Göğüs Cerrahisi Anabilim Dalı.; 0000-0003-4820-2288; AAG-9356-2021; AAU-8952-2020; 57198133515; 6602405968; 57207553671; 6505818048; 8705640100; 6603825848
The most important dilemma in the diagnosis of ventilator-associated pneumonia (VAP) based on only clinical findings is overdiagnosis. The aim of the study is to prospectively evaluate the Clinical Pulmonary Infection Score (CPIS) in relation to VAP diagnosis. Design. Prospective, in a cohort of mechanically ventilated patients. Setting. The intensive care unit of a university hospital. Patients. Fifty patients, on mechanical ventilation therapy for more than 48 hours, suspected of having VAP were enrolled in the study and bacteriologic confirmation was done by bronchoalveolar lavage (BAL) culture. Interventions. Bronchoscopy with BAL fluid culture after establishing a clinical suspicion of VAP in patients having no prior antibiotic therapy or no change in current antibiotic therapy within last three days before BAL. CPIS scores during diagnosis were 6+/-2 (3-9) (median+/-QR, maximum-minimum) and it was 7+/-2 (2-9) at the 72nd hour, in 41 cases with a diagnosis of VAP. In cases with no diagnosis of VAP, the CPIS scores were found to be 6+/-2 (4-8) and 5+/-3 (2-7), respectively. There was no significant difference between the VAP group and the non-VAP group at diagnosis, but was significant at 72nd hour (respectively, p=0.551 and p=0.025). CPIS scores during diagnosis were 6+/-3 (4-8) (median+/-QR, maximum-minimum) and 7+/-4 (2-8) at the 72nd hour, in 14 cases with a diagnosis of early-onset VAP. In cases with a diagnosis of late-onset VAP, the CPIS scores were found to be 6+/-2 (3-9) and 7+/-2 (3-9), respectively. There was no significant difference between the early-onset VAP group and the late-onset VAP group. In conclusion, the CPIS results should be evaluated carefully in the clinical setting during the diagnosis.
Evde mekanik ventilasyon uygulaması
(Uludağ Üniversitesi, 2005-05-25) Kaya, Fatma Nur; Kahveci, Ferda; Kutlay, Oya; Uludağ Üniversitesi/Tıp Fakültesi/Anesteziyoloji ve Reanimasyon Anabilim Dalı.
Evde mekanik ventilasyon uygulaması, tam veya kısmi ventilasyon desteği gereken, kliniği stabil, kronik solunum yetmezliği olan olguların tedavisinde kullanılmaktadır. Evde uzun süreli mekanik ventilasyon uygulanan olguyu sunduk. 86 yaşında erkek olgu, TUR-P operasyonunun ikinci gününde klinikte ani kardiyak arrest gelişmesi üzerine, kardiyopulmoner resüsitasyonu takiben yoğun bakım ünitesine (YBÜ) alındı (APACHE II Skoru:30, GKS:3). Olgu konjestif kalp yetmezliği ve kronik obstrüktif akciğer hastalığı hikayesine sahipti. Ventilatör desteğinden tamamen ayrılamadı. Ventilatöre bağımlı olgu için YBÜ’de sekizinci ayından sonra evde mekanik ventilasyon programı planlandı. Olgu eve gönderilmeden önce, tedavisinde gerekli spesifik ihtiyaçları ve olgunun bakımından sorumlu kişinin eğitimi sağlandı. Kronik obstrüktif akciğer hastalığı akut atağının tedavisi ve fizik muayene için YBÜ uzmanı tarafından düzenli ziyaretleri yapıldı. Olgu yirmi iki ay sonra öldü. Bu dönemde iki kez YBÜ desteği gerekli oldu.
Experience of pandemic influenza A (H1N1) 2009
(Aves, 2012-12-01) Kebabçı, Nesrin; Akalın, Halis; Bölük, Gülçin; Oğuz-Ayarcı, Ayşe; Kazak, Esra; Topal, Uğur; Yorulmaz, Hakan; Akköse, Şule; Özvatan-Şener, Tülay; Aslan, Emel; Köprücüoğlu, Duygu; Heper, Yasemin; Yılmaz, Emel; Kahveci, Ferda; Mıstık, Reşit; Helvacı, Safiye; Kebabçı, Nesrin; AKALIN, EMİN HALİS; Bölük, Gülçin; Oğuz-Ayarcı, Ayşe; KAZAK, ESRA; Topal, Uğur; Yorulmaz, Hakan; Akköse, Şule; Özvatan-Şener, Tülay; Aslan, Emel; Köprücüoğlu, Duygu; HEPER, YASEMİN; YILMAZ, EMEL; KAHVECİ, FERDA ŞÖHRET; Mıstık, Reşit; Helvacı, Safiye; Uludağ Üniversitesi/Tıp Fakültesi/İnfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Radyoloji Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/İç Hastalıkları Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Acil Tıp Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Göğüs Hastalıkları Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Anesteziyoloji ve Reanimasyon Anabilim Dalı.; 0000-0001-7530-1279; 0000-0002-3894-1231; 0000-0003-4820-2288; FCW-3335-2022; AAU-8952-2020; KFT-0453-2024; FOZ-1105-2022; AAG-8459-2021; JLP-0593-2023; EIO-1059-2022; EJV-1316-2022; FQE-4671-2022; EJJ-4181-2022; FGO-0266-2022; AAH-6506-2021; HJZ-6992-2023; AAG-9356-2021; DFY-3761-2022; EXQ-2687-2022
Objective: Pandemic influenza A (H1N1) 2009 first appeared in April, 2009 in Mexico and affected the entire world. The objective of this study is to analyze epidemiological, clinical and laboratory findings of probable or confirmed pandemic inluenza A (H1N1) 2009 adult cases who were admitted to our clinic.Methods: Eighty-five patients with pandemic influenza A (H1N1) 2009 admitted to Uludag University Hospital between November 3, 2009 and January 22, 2010 were retrospectively evaluated.Results: Of the 85 cases, 44 (51.8%) were females and 41 (48.2%) were males. The median age was 33 (17-82). 16 of cases (18.8%) were assessed as accurate, and 69 (81.2%) as probable cases of influenza. Pneumonia was diagnosed in 17 (20%) patients by evaluating clinical findings and chest X-ray. Eleven of the cases were treated in the Intensive Care Unit. Seventy-one (83.5%) of the cases were treated by oseltamivir. Mean duration of treatment was 10 days. The mortality rate of the cases was 4.7%.Conclusions: Pandemic influenza A (H1N1) 2009 perpetuates its epidemic potential as in the past years. The disease is frequently accompanied by pneumonia during its course.
Fatal hydrothorax due to misplacement of a nasoenteric feeding tube
(Sage Publications, 2001) Acar, H. Volkan; Kahveci, Ferda; İşçimen, Remzi; Gurbet, Alp; Uysal, Hale Yarkan; Kutlay, Özden; Uludağ Üniversitesi/Tıp Fakültesi/Anesteziyoloji Anabilim Dalı.; AAG-9356-2021; 6602742300; 7007146835; 16645821200; 35618853300; 8290444400; 6602199747
Blind nasoenteric intubation was attempted in a patient with chronic parkinsonism. The tube was inadvertently misplaced and penetrated the left pleural cavity. The next day, the patient developed cardiopulmonary arrest during dietary supplement infusion. This complication ultimately led to the patient's death. We have reviewed the known complications of nasoenteric tube placement and conclude that difficult insertion in patients at risk from tube misplacement should be followed by chest radiography to confirm the correct placement of the tube before nutritional support is started.
Fatal pneumococcal purpura fulminans in an asplenic patient
(Doc Design Informatics Co Ltd, 2008-08-01) Kahveci, Ferda; Kuruefe, Necmi Riza; KELEBEK GİRGİN, NERMİN; Kelebek-Girgin, Nermin; Akalin, Halis; Yılmaz, Emel; YILMAZ, EMEL; AKALIN, EMİN HALİS; Özcan, Berin; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Klinik Mikrobiyoloji Anabilim; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Anestezi ve Reanimasyon Anabilim; 0000-0001-7530-1279; AAU-8952-2020
Splenectomized patients are at an increased risk of serious infection with encapsulated bacteria such as Streptococcus pneumoniae. Purpura fulminans is a rare complication of Streptococcus pneumoniae infections, and occurs with acute onset characterized by cutaneous ecchymoses, symmetrical gangrene of the extremities, renal failure and disseminated intravascular coagulation. A 41-year-old woman admitted to the emergency department with shivering, high fever and sore throat persisting for 2 days. It was learned that she had had a splenectomy 30 years ago and she was not regularly vaccinated with pneumococcal vaccine. After taking blood cultures, treatment with intravenous antibiotic was started. Within a short time, haemorrhagic and ecchimotic rashes occurred on her face and were spread throughout the body. Her condition rapidly deteriorated and she died within 36 hours. Streptococcus pneumoniae was identified in her blood culture.
Incidence, characteristics and risk factors of delirium in the intensive care unit: An observational study
(Wiley, 2022-01-03) ERBAY DALLI, ÖZNUR; KELEBEK GİRGİN, NERMİN; Girgin, Nermin Kelebek; Kahveci, Ferda; KAHVECİ, FERDA ŞÖHRET; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Anestezi ve Reanimasyon Anabilim Dalı.; 0000-0003-2282-0846; 0000-0002-5882-1632; ABI-1236-2020
Aims and Objective To investigate the incidence, characteristics and risk factors of delirium in the ICU. Background Identifying the risk factors of delirium is important for early detection and to prevent adverse consequences. Design An observational cohort study conducted according to STROBE Guidelines. Method The study was conducted with patients who stayed in ICU >= 24 h and were older than 18 years. Patients were assessed twice daily using the RASS and CAM-ICU until either discharge or death. Cumulative incidence was calculated. Demographic/clinical characteristics, length of stay and mortality were compared between patients with and without delirium. A logistic regression model was used to investigate risk factors. Results The incidence of delirium was 31.8% and hypoactive type was the most frequent (41.5%). The median onset of delirium was 3 days (IQR = 2) with a mean duration of 5.27 +/- 2.32 days. Patients with delirium were significantly older, had higher APACHE-II, SOFA and CPOT scores, higher blood urea levels, higher requirements for mechanical ventilation, sedation and physical restraints, longer stays in the ICU and higher mortality than those without delirium. The logistic regression analysis results revealed that a CPOT score >= 3 points (OR = 4.70, 95% CI: 1.05-20.93; p = .042), physical restraint (OR = 10.40, 95% CI: 2.75-39.27; p = .001) and ICU stay >= 7 days (OR = 7.26, 95% CI: 1.60-32.84; p = .010) were independent risk factors of delirium. Conclusions In this study, the incidence of delirium was high and associated with several factors. It is critical that delirium is considered by all members of the healthcare team, especially nurses, and that protocols are established for improvements. Relevance to the clinical practice Based on the results of this study, delirium could be decreased by preventing the presence of pain, prudent use of physical restraints and shortening the ICU stay.
Infection control principles in intensive care unit: International standards
(Galenos Yayıncılık, 2007-02-01) Kahveci, Ferda; KAHVECİ, FERDA ŞÖHRET; Uludağ Üniversitesi/Tip Fakültesi/Anesteziyol Reanimasyon Anabilim Dalı; CYR-2043-2022
Infection control principles in intensive care unit: International standardstu
(Galenos Yayincilik, 2007-01-01) Kahveci, Ferda; KAHVECİ, FERDA ŞÖHRET; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Anestezi ve Reanimasyon Anabilim Dalı.
International transplant network (ITN) project for developing countries: Analysis and discussion of the 1st phase's findings
(Frontiers Media, 2017-09) Kahveci, Eyüp; Utku, Tuğhan; Seren, Arzu Kader Harmancı; Gecegörmez, Sevgi Aydemir; Yıldırım, Gamze; Ordin, Yaprak Sarıgöl; Çınar, Yavuz Selim; Anık, Esin Gülkaya; Karayurt, Özgül; Canbulat, Başak; Bozoklar, Ata; Kahveci, Ferda; Uludağ Üniversitesi/Tıp Fakültesi/Anesteziyoloji ve Reanimasyon Anabilim Dalı.
Intravenous immunoglobulin in adult varicella pneumonia complicated by acute respiratory distress syndrome
(Sage Publications, 2001) Özcan, Birgül; Tokat, O.; Girgin, Nermin Kelebek; Türker, Gürkan; Kahveci, Ferda; Uludağ Üniversitesi/Tıp Fakültesi/Anesteziyoloji Anabilim Dalı.; 0000-0002-3019-581X; 0000-0003-4820-2288; AAI-6642-2021; AAG-9356-2021
Pneumonia is a rare but serious complication of varicella in adults. We report a case of a previously healthy 32-year-old man with varicella pneumonia that was complicated by acute respiratory distress syndrome. He was treated successfully with acyclovir and intravenous immunoglobulin in to mechanical ventilation. We conclude that intravenous immunoglobulin, in combination with acyclovir, is a safe and probably effective therapy for adult varicella pneumonia that is complicated by acute respiratory distress syndrome.
Nosocomial Acinetobacter pneumonia: Treatment and prognostic factors in 356 cases
(Wiley, 2015-08-31) Özvatan, Tülay; Akalın, Halis; Sınırtaş, Melda; Ocakoğlu, Gökhan; Yılmaz, Emel; Heper, Yasemin; Kelebek, Nermin; İşçimen, Remzi; Kahveci, Ferda; Uludağ Üniversitesi/Tıp Fakültesi/Enfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Mikrobiyoloji ve Klinik Mikrobiyoloji Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Biyoistatistik Anabilim Dalı.; 0000-0001-8111-5958; 0000-0003-4820-2288; 0000-0002-3894-1231; AAG-9356-2021; AAU-8952-2020; AAI-8104-2021; AAH-6506-2021; AAH-5180-2021; 57074087100; 57207553671; 6505818048; 57073882900; 22037135100; 56191003300; 7801569062; 16645821200; 6602405968
Background and objective: Acinetobacter baumannii and A. baumannii/calcoaceticus complex are commonly encountered pathogens in nosocomial infections. This study aimed to evaluate the treatment and prognostic risk factors in nosocomial pneumonia caused by these microorganisms. Methods: The study was conducted retrospectively in Uludag University Hospital and included 356 adult non-neutropenic patients with nosocomial pneumonia. Results: Of the subjects, 94.9% (n = 338) had ventilator-associated pneumonia. The clinical response rate was 57.2%, the 14-day mortality 39.6% and the 30-day mortality 53.1%. The significant independent risk factors for the 30-day mortality were severe sepsis (OR, 2.60; 95% CI: 1.49-4.56; P = 0.001), septic shock (OR, 6.12; 95% CI: 2.75-13.64; P < 0.001), APACHE II score >= 20 (OR, 2.12; 95% CI: 1.28-3.50; P = 0.003) and empiric monotherapy (OR, 1.63; 95% CI: 1.00-2.64; P = 0.048). Multi-trauma (OR, 2.50; 95% CI: 1.11-5.68; P = 0.028) was found to be a protective factor. In patients with a clinical pulmonary infection score (CPIS) > 6 on the third day of treatment, both the 14- and 30-day mortality rates were high (P < 0.001, P < 0.001). Also, the 14- and 30-day mortality rates were significantly higher in the patients treated with empiric monotherapy compared with combination therapy (48/93 (51.6%)-46/123 (37.4%), P = 0.037 and 62/93 (66.7%)-65/123 (52.8%), P = 0.041, respectively) in pneumonia caused by imipenem-resistant strains. Conclusion: Mortality rates were high in pneumonia caused by imipenem-resistant A. baumannii or A. baumannii/calcoaceticus complex. In the units with a high level of carbapenem resistance, antibiotic combinations should be considered for empiric therapy.
Oxa-48 dominance meets ceftazidime-avibactam: A battle against life-threatening carbapenem-resistant klebsiella pneumoniae infections in the intensive care unit
(Springernature, 2023-10-10) Önal, Uğur; Tüzemen, Ülkü; Kaya, Pınar K.; İşçimen, Remzi; Girgin, Nermin Küçükdemirci; Özakın, Cüneyt; Kahveci, Ferda; Akalın, Halis; ÖNAL, UĞUR; TÜZEMEN, NAZMİYE ÜLKÜ; KÜÇÜKDEMİRCİ KAYA, PINAR; ÖZAKIN, CÜNEYT; KAHVECİ, FERDA ŞÖHRET; İŞÇİMEN, REMZİ; Girgin, Nermin Küçükdemirci; AKALIN, EMİN HALİS; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Enfeksiyon Hastalıkları; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Mikrobiyoloji Bölümü; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Anesteziyoloji ve Yoğun Bakım; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Yoğun Bakım Ünitesi; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Tıbbi Mikrobiyoloji; 0000-0001-6194-3254; 0000-0002-8428-8245; JCO-3678-2023; JCO-2264-2023; JNY-9122-2023; JMU-3479-2023; DTU-3148-2022; JNH-9929-2023; CYR-2043-2022; CYR-2043-2022; AAU-8952-2020
ObjectiveIn this study, we aimed to describe the outcomes in ICU patients with bloodstream infection (BSI) or ventilatory-associated pneumonia (VAP) due to carbapenem-resistant Klebsiella pneumoniae (CRKP) who received ceftazidime-avibactam treatment at a tertiary care university hospital.MethodsPatients aged 18 years or older who were admitted to the Anesthesiology and Reanimation ICU at Bursa Uludag University Faculty of Medicine Hospital between June 13, 2021, and July 16, 2023, and diagnosed with BSI or VAP due to CRKP were included in this study.ResultsA total of 42 patients treated with ceftazidimeavibactam were included. Total crude mortality rates were 33.3% on day 14 and 54.8% on day 30. Mortality rates on the 14th and 30th days were 37.5% and 62.5% in patients with BSI and 27.8% and 44.4% in patients with VAP, respectively. There was no statistically significant difference between monotherapy and combination therapy in terms of mortality rates on days 14 and 30, respectively (3/11 vs. 11/31, p=0.620; 5/11 vs. 18/31, p=0.470). Immunosuppression (10/11 vs. 13/31, p=0.005), the Sequential Organ Failure Assessment (SOFA) score >= 8 (at the initiation of treatment; 19/25 vs. 4/17, p<0.001), INCREMENT-CPE score >= 10 (12/16 vs. 3/10, p=0.024) and longer duration (in days) from culture collection to treatment initiation (5.0 +/- 0.61 vs. 3.11 +/- 0.48, p=0.024) were found to have a statistically significant effect on 30-day mortality. In multivariate analysis, a SOFA score >= 8 at the initiation of treatment (p=0.037, OR: 17.442, 95% CI: 1.187-256.280) was found to be a significant risk factor affecting mortality (30-day).ConclusionThe mortality rates of patients with CRKP infection who were followed up in the ICU were found to be high, and it was observed that whether ceftazidime-avibactam treatment was given as a combination or monotherapy did not affect mortality. Further multicentre studies with a larger number of patients are needed to gain a comprehensive understanding of the topic, given that this treatment is typically reserved for documented infections.