Oś przysadka–gonady–tarczyca i oś laktotropowa u chorych w stanie krytycznym

  Introduction: The normal circadian rhythm of hormones in critical patients becomes chaotic causing some hormones to increase and others to decrease abnormally. The goal of this study is to evaluate hormonal changes in severely ill patients and to investigate the relationship between hormonal changes and mortality and morbidity. Material and methods: We enrolled 20 patients (10 F/10 M). Blood samples were collected on day 0, day 5, and day 10. If a patient was discharged before these defined days, a sample was drawn on that day. Twenty healthy controls were included. Results: Female patients had lower LH, FSH, and fT3 and higher PRL and cortisol levels than controls on admission to the intensive care unit (ICU) (pLH = 0.021, pFSH:0.001, pfT3 = 0.021, pPRL = 0.042, pCortisol <0.001, respectively). Men had significantly low testosterone and fT3, and high PRL and cortisol levels on ICU admission (pT = 0.01, pfT3 = 0.043, pPRL = 0.005, pCortisol < 0.001, respectively). The lowest levels of gonadotropins in both genders and testosterone in men were measured on day 5. Cortisol levels decreased in the patients discharged from the ICU (p = 0.01). FSH levels increased in recovered women (pFSH = 0.043). The mortality rate was 30%. There were correlations between admission TSH and NIMV duration (p = 0.006), fT3 and APACHE II (p = 0.001), and PRL and mortality (p = 0.044). Positive correlations between E2 and APACHE II (p = 0.003) in females, and PRL and APACHE II (p = 0.022) in males were also displayed. Conclusions: Critically ill patients develop significant changes in neuroendocrine axes. Alterations in hormones correlate with the disease severity and mortality. (Endokrynol Pol 2016; 67 (3): 305–312)    Wstęp: Prawidłowy rytm dobowy wydzielania hormonów u chorych w stanie krytycznym staje się chaotyczny — wydzielanie jednych hormonów nadmiernie się zwiększa, natomiast innych maleje. Badanie przeprowadzono w celu oceny zmian stężeń hormonów u osób ciężko chorych oraz zbadanie zależności między zmianami stężeń hormonów a śmiertelnością I chorobowością. Materiał i metody: Do badania włączono 20 chorych (10 K/10 M). Próbki krwi pobierano w dniach 0, 5 i 10. Jeśli pacjent został wypisany przed tymi dniami, próbkę pobierano w dniu wypisu. Utworzono również grupę kontrolną złożoną z 20 zdrowych osób. Wyniki: U kobiet stwierdzono niższe stężenia LH, FSH i fT3 oraz wyższe stężenia PRL i kortyzolu przy przyjęciu na oddział intensywnej opieki medycznej (OIOM) niż u osób z grupy kontrolnej (odpowiednio pLH = 0,021; pFSH = 0,001; pfT3 = 0,021; pPRL = 0,042; pCortisol < 0,001). U mężczyzn w chwili przyjęcia na OIOM stężenia testosteron i fT3 były istotnie niższe, a stężenia PRL i kortyzolu wyższe niż w grupie kontrolnej (odpowiednio pT = 0,01; pfT3 = 0,043; pPRL = 0,005; pCortisol < 0,001). Najniższe stężenie gonadotropin u obu płci, a testosteron u mężczyzn zmierzono w dniu 5. Stężenia kortyzolu zmniejszyły się u chorych wypisanych z OIOM-u (p = 0,01). Stężenia FSH zwiększyły się u kobiet, których stan się poprawił (pFSH = 0,043). Odsetek zgonów wynosił 30%. Występowały korelacje między stężeniem TSH przy przyjęciu na OIOM a czasem stosowania nieinwazyjnej wentylacji mechanicznej (p = 0,006), fT3 i oceną w skali APACHE II (p = 0,001) oraz między stężeniem PRL a śmiertelnością (p = 0,044). Stwierdzono także dodatnie korelacje między stężeniem E2 a oceną w skali APACHE II (p = 0,003) u kobiet oraz między stężeniem PRL a ocean w skali APACHE II (p = 0,022) u mężczyzn. Wnioski: U chorych w stanie krytycznym występują istotne zaburzenia osi neuroendokrynnych. Zmiany stężeń hormonów korelują z ciężkością choroby I śmiertelnością. (Endokrynol Pol 2016; 67 (3): 305–312)

The Multipath Influence in Real-Time Kinematic of GNSS Observations at Different Antenna Heights

Multipath is a dominant error source in Real-Time Kinematic (RTK) applications that reduces the position, time and velocity accuracy. Mitigation of such errors can be achieved by better signal processing and antenna design. This paper attempts to examine the different height of RTK system antenna with regards to the multipath error. The results obtained in this work show height significantly change of multipath in pseudo range (MP1) and multipath in the carrier phase (MP2). Different antenna height does not give the same multipath error result in the tests that we have conducted in this work. The optimal height of the antenna was achieved as two meters in order to obtain a minimum multipath error for   MP1 and MP2. At the end of this work, we experimentally proved that there is an inverse relationship between the height of the antenna and multipath with RTK algorithm

Myocardial injury in COVID-19 patients is associated with the thickness of epicardial adipose tissue

Aim High sensitive troponin (hs-TnI) levels may increase secondary to Coronavirus disease-2019 (COVID-19), and this increase is associated with cardiovascular mortality in COVID-19 patients. Epicardial adipose tissue (EAT) is associated with myocardial injury directly as a reservoir tissue for coronavirus, and indirectly through mediators it secretes as an apocrine gland. We aimed to evaluate the relationship between myocardial injury secondary to COVID-19 infection and EAT thickness. Material and methods Thoracic computed tomography (CT) was performed in 73 consecutive patients diagnosed with COVID-19. EAT thickness and volume were calculated by two radiologists blind to the study data. We formed two groups according to hs-TnI concentrations, patients with myocardial damage (hs-TnI >= 11.6 ng/l) and without myocardial damage (hs-TnI<11.6 ng/dl). Results A total of 46 patients were women (63.0%). The mean age was 66.4 +/- 12.3 yrs in the myocardial injury group and 55.9 +/- 9.7 yrs in the group without myocardial injury (p<0.001). There were 20 hypertensive patients (68.9%) in the injury group, while there were 12 hypertensive patients (27.3%) in the group without injury (p=0.001). Glucose, C-reactive protein, D-dimer, white blood cell count, neutrophil, and neutrophil/lymphocyte ratio were higher in the injury group (p<0.05, for all variables). The mean EAT thickness was 5.6 +/- 1.6 mm in the injury group, whereas it was 4.8 +/- 1.8 mm in the group without injury (p=0.031). EAT thickness of 4.85 mm and above was associated with the myocardial injury with 65% sensitivity and 39% specificity (AUC=0.65, 95% CI: 0.52-078, p=0.031). Conclusion In patients with COVID-19 infection, higher rates of myocardial injury were observed as the EAT thickness increased. Epicardial adipose tissue, contributes to cytokine-mediated myocardial injury either directly or indirectly by acting as a reservoir for coronavirus. Increased EAT thickness is associated with myocardial injury in COVID-19 patients

ATIK MERMER TOZU VE CAM LĠF KATKILI BETONLARIN BASINÇ DAYANIMLARININ YAPAY SĠNĠR AĞLARI ĠLE TAHMĠNĠ

Bu çalışmada, su/çimento oranı 0,60 olan, 300 ve 350 dozlu betonların üretimi sırasında karışıma 4 farklı oranda kırpılmış cam lif ilave edilerek elde edilen bu serilere filler malzeme ile hacimce %25, 50, 75 ve 100 oranlarında yer değiştirecek şekilde atık mermer tozu ilave edildi. Elde edilen numunelerin ultrases geçiş hızları, porozite değerleri, yarmada çekme dayanımları ve basınç dayanımları belirlendi. Yapay sinir ağına (YSA) girdi seti olarak dozaj, agrega miktarı, lif oranı, mermer tozu oranı, porozite, ultrases geçiş hızı ve yarmada çekme dayanımı değerleri seçilerek basınç dayanımları tahmin edildi. Çalışma sonucunda, geliştirilen YSA modeli ile deneysel olarak elde edilen veriler karşılaştırıldı ve sonuçların uyum içerisinde olduğu belirlendi

YAPAY SĠNĠR AĞLARI ĠLE ATIK MERMER TOZU VE CAM LĠF KATKILI BETONLARIN YARMADA ÇEKME DAYANIMLARININ TAHMĠNĠ

Bu çalışmada; 4 farklı oranda cam lif ilave edilerek elde edilen 300 ve 350 dozlu betonlara filler malzeme ile hacimce %25, 50, 75 ve 100 oranlarında yer değiştirecek şekilde atık mermer tozu ilave edildi. Elde edilen numunelerin ultrases geçiş hızları, porozite değerleri, basınç dayanımları ve yarmada çekme dayanımları belirlendi. Yapay sinir ağına (YSA) girdi seti olarak dozaj, agrega miktarı, lif oranı, mermer tozu oranı, porozite, ultrases geçiş hızı ve basınç dayanımı değerleri seçilerek yarmada çekme dayanımları tahmin edildi. Çalışma sonucunda, geliştirilen YSA modeli ile deneysel olarak elde edilen veriler karşılaştırıldı ve sonuçların uyum içerisinde olduğu belirlendi

COVID-19 hastalarında mitral anüler kalsifikasyonun mortalite ve miyokard hasarı ile ilişkisi

Coronavirus disease-2019 (COVID-19) can particularly affect the respiratory and cardiovascular systems and cause serious mortality. Mitral annular calcification (MAC) is a mitral valve pathology associated with cardiac mortality. We aimed to evaluate the effect of MAC on myocardial injury (MI) and mortality, which can develop secondary to COVID-19 infection. Materials and Methods After applying the exclusion criteria, thorax computed tomography (CT) images of the remaining 1151 consecutive COVID-19 patients were evaluated. Calculation of MAC scores was done by two expert radiologists blinded to the study data. MI was defined as those with hs-TnI level (≥34 ng/dl). Patients included in the study were classified as having mortality and not occurring. Results Male gender, advanced age (>65), hypertension, diabetes mellitus, chronic obstructive pulmonary disease, chronic kidney disease (CKD), coronary artery disease, heart failure and atrial fibrillation rates were statistically higher in the mortality group (p<0.05). The presence of MAC was 34.1% in the mortality group, while it was 16% in the survival group (p<0.001). MI was observed 49.3% in the mortality group, while it was 16.2% in the survival group (p<0.001). Presence of MAC was associated with MI (14.8% vs 38.7%, p<0.001). Age (OR=1.976, 95% CI 1.166-3.346, p=0.011), male gender (OR=1.784, 95% CI 1.101-2.892, p=0.019), CKD (OR=2.293, 95% CI 1.085-4.485, p=0.030), MI (OR=2.893, 95% CI 1.735-4.823, p<0.001) and advanced lung involvement on CT (OR=2.231, 95% CI 1.084-4.594, p=0.029) were the independent predictors of mortality Conclusion In terms of MI and mortality risk in COVID-19 patients, it may be recommended to evaluate MAC from the CT images.Koronavirüs hastalığı-2019 (COVID-19) özellikle solunum ve kardiyovasküler sistemleri etkileyerek mortaliteye ve ciddi morbiditelere neden olabilir. Mitral halka şeklindeki kalsifikasyon (MAC), kardiyak mortalite ile ilişkili bir mitral kapak patolojisidir. Bu çalışmada, MAC’ın COVID-19 enfeksiyonuna sekonder gelişebilen miyokard hasarı (MI) ve mortalite üzerine etkisini değerlendirmeyi amaçladık. Gereç ve Yöntemle Dışlama kriterleri uygulandıktan sonra geriye kalan 1151 ardışık COVID-19 hastasının toraks bilgisayarlı tomografi (BT) görüntüleri değerlendirildi. MAC puanlarının hesaplanması, çalışma verilerine kör olan iki uzman radyolog tarafından yapıldı. MI, hs-TnI düzeyi (≥34 ng/dl) olanlar olarak tanımlandı. Çalışmaya dahil edilen hastalar mortalitesi olan ve olmayan olarak sınıflandırıldı. Bulgular Mortalite grubunda erkek cinsiyet, ileri yaş (>65), hipertansiyon, diabetes mellitus, kronik obstrüktif akciğer hastalığı, kronik böbrek hastalığı (KKD), koroner arter hastalığı, kalp yetmezliği ve atriyal fibrilasyon oranları istatistiksel olarak daha yüksekti (p<0.05). Mortalite grubunda MAC varlığı %34.1, sağkalım grubunda ise %16 idi (p<0.001). Miyokardiyal hasar mortalite grubunda %49.3, sağkalım grubunda ise %16.2 olarak saptandı (p<0.001). MAC varlığı MI ile ilişkiliydi (%14.8’e karşılık %38.7, p<0.001).Yaş (OR=1.976, 95% CI 1.166-3.346, p=0.011), erkek cinsiyet (OR=1.784, 95% CI 1.101-2.892, p=0.019), kronik böbrek yetersizliği (OR=2.293, 95% CI 1.085-4.485, p=0.030), MI (OR=2.893, 95% CI 1.735-4.823, p<0.001) ve küçük hücreli akciğer tutulumu (OR=2.231, 95% CI 1.084-4.594, p=0.029) mortalitenin bağımsız belirleyicileri idi. Sonuç COVID-19 hastalarında MI ve mortalite riski açısından BT görüntülerinden MAC değerlendirilmesi önerilebilir

Continuous spinal anesthesia application in a patient with high cardiac risk: Case report

Alt ekstremite cerrahisi anestezisinde, genel anesteziden çok rejyonel yöntemler tercih edilmektedir. Özellikle yaşlı ve yüksek kardiyak riskli hastalarda hemodinamik stabiliteyi koruyarak yeterli anestezi sağlanması temel amaçtır. Acil sağ diz üstü amputasyon planlanan 63 yaşındaki kadın hasta, altı gün önce ST yükselmesiz miyokard infarktüsü (Mİ) tanısı konularak tedavi edilmişti. Olgunun 15 yıldır tip 2 diabetes mellitusu, 10 yıldır hipertansiyonu vardı. İki yıl önce iki damar baypas ile mitral annuloplasti ve iki ay önce sağ diz altı amputasyon uygulanmıştı. Sağ lateral pozisyonda, L3-4 intervertebral aralıktan kateter içinden iğne tekniği ile intratekal kateter yerleştirildi. Serbest BOS akışı görüldükten sonra 2.5 mg %0.5'lik bupivakain uygulandı. Yeterli duyusal blok seviyesi sağlanana kadar her beş dakikada bir tekrarlanan 2.5 mg'lık dozlarla toplam 7.5 mg %0.5 bupivakain uygulanarak anestezi sağlandı. Duyusal blok T10 seviyesine ulaştıktan sonra sırtüstü pozisyon verildi. Ameliyat süresince hemodinamik olarak stabil seyreden olguya kateterden ek ilaç uygulanmadı ve bir saatlik ameliyat sonunda spinal kateteri çıkarılarak servise gönderildi. Sonuç olarak, özellikle yaşlı ve kardiyak riski yüksek olgularda alt ekstremite ameliyatları için sürekli spinal anestezi tekniğinin uygun bir anestezi seçeneği olarak kullanılması gerektiğini düşünmekteyizRegional techniques are preferred to general anesthesia in lowerextremity surgery. Especially in elderly patients with high cardiac risk, the main objective is to supply sufficient anesthesia preserving hemodynamic stability. A 63-year-old female patient in whom emergency right leg amputation above the knee was planned, was treated for myocardial infarction without ST elevation 6 days ago. She had type 2 diabetes mellitus for 15 years, and hypertension for 10 years. She underwent a coronary bypass operation for two vessels and mitral annuloplasty two years ago and right leg amputation below the knee two months ago. An intrathecal cathater was placed at the right lateral position from L3-4 intervertebral space through the cathater by the needle technique. After cerebrospinal fluid flow was observed, we administered 2,5 mg 0.5% bupivacaine. Anesthesia was maintained by performing 2.5 mg of bupivacain every five minutes at a total dose of 7.5 mg until adequate sensory block was reached. The patient was given a supine positione after the sensory block reached T10 level. The patient was hemodynamically stable during the operation and did not require additional drug from the catheter. The patient was sent to the ward after removing spinal cathater at the end of a one hour operation. In conclusion, especially in old patients with high cardiac risk, we think that continuous spinal anesthesia should be the method of choice for anesthesia in lower-extremity surgery

Epicardial fat thickness is associated with retinopathy in patients with newly diagnosed hypertension

OBJECTIVE: Hypertensive retinopathy develops based on endothelial dysfunction, inflammation, and atherosclerosis. Epicardial fat secretes various cytokines associated with endothelial dysfunction, oxidative stress, inflammation, and atherosclerosis. We aimed to evaluate whether epicardial adipose tissue (EAT) thickness is a marker for retinopathy in newly diagnosed hypertensive patients. METHODS: A total of 73 newly diagnosed hypertension (HT) patients were included in the study. Transthoracic echocardiography (TTE) was used to measure EAT thickness. To evaluate the presence of retinopathy in HT patients, hypertensive retinopathy staging was performed by ophthalmologists, according to Scheie classification. RESULTS: Retinopathy was detected in 27 (37.0%) of 73 patients. EAT thickness in HT patients with retinopathy was higher than the group without retinopathy (5.07 +/- 1.45 mm vs. 4.19 +/- 1.20 mm, p=0.007). Low-density lipoprotein cholesterol (LDL-C) levels in HT patients with retinopathy were higher than the group without retinopathy (162.4 +/- 41.2 mg/dl vs. 138.1 +/- 35.6 mg/dl, p=0.010). As a result of the regression analysis, LDL-C (OR=1.016, 95% CI 1.001-1.031, p=0.043) and EAT thickness (OR=1.674, 95% CI 1.069-2.626, p=0.043) were the independent predictors of retinopathy. CONCLUSION: Increased EAT thickness is associated with the presence of retinopathy in hypertensive patients

Adenomatöz kolon polipli hastalarda oksidatif stres mekanizmasının paraoksonaz ve arilesteraz üzerinden değerlendirilmesi

Amaç: Adenomatöz polip, rektum ve kolonda adenomların lümene doğru gelişimi ile karakterize klinik bir durumdur. Birçok dejeneratif ve tümöral hastalığın patogenezinde artmış oksidatif stres rol oynamaktadır. Bu çalışma adenomatöz kolon polipli hastalarda paraoksonaz, indüklenebilir paraoksonaz ve arilesteraz enzim aktivitelerinin tespiti ve oksidatif stres ile hastalığın patofizyolojisi arasındaki ilişkiyi ortaya koymak amacı ile planlanmıştır. Gereç ve yöntem: Namık Kemal Üniversitesi Araştırma ve Uygulama Hastanesi Gastroenteroloji Polikliniği’ne başvuran hastalardan kolon polipi saptananlar ve sağlıklı gönüllüler çalışmaya alındı. Paraoksonaz, indüklenebilir paraoksonaz ve arilesteraz düzeylerinin ölçümleri spektrofotometrik olarak yapıldı. Bulgular: Kolon polipli hastalar ile sağlıklı kontroller karşılaştırıldığında, kolon polipli hastalarda, paraoksonaz, indüklenebilir paraoksonaz aktiviteleri istatistiksel olarak anlamlı oranda düşük bulunurken, arilesteraz aktivitesinde istatistiksel olarak anlamlı fark bulunmadı. Sonuç: Kolon polipli hastalarda paraoksonaz ve indüklenebilir paraoksonaz aktivitesinin sağlıklı polülasyondan düşük bulunması, oksidan-antioksidan dengenin oksidan yönünde bozulmasının polipli hastalarda polip gelişimi ile yakın ilişki içinde olduğunu düşündürmektedi