The Predictivity of Serum Biochemical Markers in Acute Biliary Pancreatitis

Background and Aim. There are no accurate methods of differentiating acute biliary pancreatitis. Obstructions of biliary ducts, idiopathic pancreatitis may be related with biliary origin which needs identification for acute treatment. We searched for the predictivity of biochemical markers in early acute biliary pancreatitis. Patients and Methods. Serum levels of AST (Aspartate Transaminase),ALT (Alanine Transaminase), ALP (Alkaline Phosphatase), GGT (Gamma Glutamyl Transferase), total bilirubin, direct bilirubin, LDH (Lactate Dehydrogenase), amylase, lipase, CRP (C-Reactive Protein) and WBC (White Blood Cell) were measured in 157 patients with acute pancreatitis. Biliary and nonbiliary pancreatitis were differentiated by Magnetic Resonance Cholangiopancreatography (MRCP), Endoscopic Retrograde Cholangiopancreatography (ERCP), Intraoperative Cholangiopancreatography (IOC). Cut-off points of admission biochemical markers with sensitivity, specifity, positive predictive value and negative predictive value were determined after identification of significant variables. Receiver Operator Curves were plotted for each biochemical marker. Results. Serum Alkaline Phosphatase, total bilirubin, direct bilirubin, amylase and lipase levels were significantly higher in biliary pancreatitis with a positive predictive value of 80.8%, 83.9%, 81.6%, 78.8%, 79.7%. Conclusion. Increased Alkaline Phosphatase,total bilirubin, direct bilirubin, amylase and lipase levels may be used in prediction of biliary pancreatitis

Vitamin D Status in Turkey

<p><strong>Abstract</strong></p><p><strong>Background/ Aim:</strong> Vitamin D deficiency is highly prevalent condition. The aim of the present study was to assess vitamin D status in people living in Turkey.</p><p><strong>Methods:</strong> This was a single center, retrospective study on subjects who attended to Acibadem Hospitals and outpatient clinics for the measurement of 25(OH)D. Data on 25(OH)D was available for 179464 subjects.</p><p><strong>Results:</strong> Mean 25(OH)D was 19, 56 ±0,04 ng/mL and mean age of the subjects was 39, 28 ± 0, 05 years. Mean 25(OH)D of women were lower than men; (18, 79 ± 0, 05 vs 22, 07 ± 0, 09 ng/mL; p<0.001). 25(OH)D of 111510 subjects (62, 1%) was <20 ng/mL. 42592 (23, 7%) were between 20-32 ng/mL. 24276 (13, 5%) of the subjects demonstrated normal 25(OH)D levels. 25(OH)D level was excess in 776 (0, 4%) of the subjects. Three hundred and ten (0, 2%) had toxic 25(OH)D levels. Totally 85, 9% of the subjects had low 25(OH)D levels. Adolescents, adults and elderly had lower 25(OH)D levels than newborns and children (p<0.001). Vitamin D deficiency and insufficiency were more common in adolescents, adults and elderly than in new born and children (p<0.001).</p><p><strong>Conclusıons:</strong> A considerable number of subjects in our study had 25(OH)D below the normal ranges for all age groups except neonates, demonstrating that vitamin D deficiency and insufficiency in western part of the country is a major healthcare concern in Turkey.</p&gt

Türkiye'de Vitamin D Düzeyleri: Araştırma Makalesi

Background/ Aim: Vitamin D deficiency is highly prevalent condition. The aim of the present study was to assess vitamin D status in people living in Turkey. Methods: This was a single center, retrospective study on subjects who attended to Acibadem Hospitals and outpatient clinics for the measurement of 25(OH)D. Data on 25(OH)D was available for 179464 subjects. Results: Mean 25(OH)D was 19, 56 ±0,04 ng/mL and mean age of the subjects was 39, 28 ± 0, 05 years. Mean 25(OH)D of women were lower than men; (18, 79 ± 0, 05 vs 22, 07 ± 0, 09 ng/mL; p<0.001). 25(OH)D of 111510 subjects (62, 1%) was <20 ng/mL. 42592 (23, 7%) were between 20-32 ng/mL. 24276 (13, 5%) of the subjects demonstrated normal 25(OH)D levels. 25(OH)D level was excess in 776 (0, 4%) of the subjects. Three hundred and ten (0, 2%) had toxic 25(OH)D levels. Totally 85, 9% of the subjects had low 25(OH)D levels. Adolescents, adults and elderly had lower 25(OH)D levels than newborns and children (p<0.001). Vitamin D deficiency and insufficiency were more common in adolescents, adults and elderly than in new born and children (p<0.001). Conclusıons: A considerable number of subjects in our study had 25(OH)D below the normal ranges for all age groups except neonates, demonstrating that vitamin D deficiency and insufficiency in western part of the country is a major healthcare concern in Turkey.Amaç: D vitamini eksikliği oldukça yaygın bir durumdur. Bu çalışmanın amacı Türkiye'de yaşayan kişilerde D vitamini durumunu değerlendirmektir. Yöntem: Acıbadem Hastaneleri ve polikliniklere 25(OH)D ölçümü için başvuran kişiler üzerinde yapılan tek merkezli, retrospektif bir çalışmaydı. 25(OH)D'ye ilişkin veriler 179464 denek için mevcuttu. Bulgular: Ortalama 25(OH)D 19, 56 ±0,04 ng/mL ve olguların yaş ortalaması 39, 28 ± 0,05 yıldı. Kadınların ortalama 25(OH)D'si erkeklerden daha düşüktü; (18, 79 ± 0, 05'e karşı 22, 07 ± 0, 09 ng/mL; p<0,001). 111510 deneğin 25(OH)D'si (62, %1) <20 ng/mL idi. 42592 (%23, %7) 20-32 ng/mL arasındaydı. Deneklerin 24276'sı (13, %5) normal 25(OH)D düzeyleri gösterdi. Olguların 776'sında (%0,4) 25(OH)D düzeyi fazlaydı. Üç yüz on tanesinde (%0,2) toksik 25(OH)D seviyeleri vardı. Toplamda deneklerin %85,9'unda 25(OH)D düzeyi düşüktü. Ergenler, yetişkinler ve yaşlılarda 25(OH)D düzeyleri yenidoğan ve çocuklara göre daha düşüktü (p<0,001). D vitamini eksikliği ve yetersizliği adölesan, erişkin ve yaşlılarda yeni doğan ve çocuklara göre daha sık görüldü (p<0,001). Sonuç: Çalışmamızda önemli sayıda olguda yenidoğanlar hariç tüm yaş gruplarında 25(OH)D normal aralığın altındaydı; bu durum ülkenin batı kesimindeki D vitamini eksikliği ve yetersizliğinin Türkiye'de önemli bir sağlık sorunu olduğunu ortaya koymaktadır

Is Nurse Workforce Sufficient in Intensive Care Units in Turkey. Results of the Multicenter Karia Study

Introduction: In this multicenter study, we analysed the magnitude of healthcare worker (HCW) [infection control practitioner (ICP), nurses and others] workforce in hospitals participated in the study. Materials and Methods: This study was performed in 41 hospitals (with intensive care units-ICU) located in 22 cities from seven regions of Turkey. We analysed the ICP workforce, nursing and auxiliary HCW (AHCW) workforce in ICUs, number of ICU beds and occupied beds in four different days [two of which were in summer during the vacation time (August 27 and 31, 2016) and two others in autumn (October 12 and 15, 2016)]. The Turkish Ministry of Health (TMOH) requires two patients per nurse in level 3 ICUs, three patients per nurse in level 2 ICUs and five patients per nurse in level 1 ICUs. There is no standardization for the number of AHCW in ICUs. Finally, one ICP per 150 hospital beds is required by TMOH. Results: The total number of ICUs, ICU beds and ICPs were 214, 2377 and 111, respectively in he 41 participated centers. The number ICPs was adequate only in 12 hospitals. The percentage of nurses whose working experience was 2. The number of patients per other HCW was minimum 3.75 and maximum 4.89 on weekdays and on day shift while it was minimum 5.02 and maximum 7.7 on weekends or on night shift. When we compared the number of level 1, 2 and 3 ICUs with adequate nursing workforce vs inadequate nursing workforce, the p value was <0.0001 at all time points except summer weekend night shift (p=0.002). Conclusion: Our data suggest that ICP workforce is inadequate in Turkey. Besides, HCW workforce is inadequate and almost 1/4 of nurses are relatively inexperienced especially in level 3 ICUs. Turkish healthcare system should promptly make necessary arrangements for adequate HCW staffing

Neuropsychiatric involvement in juvenile-onset systemic lupus erythematosus: A multicenter study

Introduction: Neuropsychiatric (NP) involvement is a restricted area in juvenile-onset systemic lupus erythematosus (jSLE). Aim: To investigate the prevalence, demographic and clinical features, and outcomes of the neurological involvement in the Turkish jSLE population. Methods: This study was based upon 24 referral centers’ SLE cohorts, multicenter and multidisciplinary network in Turkey. Patient data were collected by a case report form which was standardized for NP definitions according to American Collage of Rheumatology (ACR). Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI) neuropsychiatric part was used to determine NP damage. Variables were evaluated Ward's hierarchical clustering analyses, univariate, and multivariate logistic regression analyses. Results: A hundred forty-nine of 1107 jSLE patients had NP involvement (13.5%). The most common NPSLE findings were headache (50.3%), seizure (38.3%), and acute confusional state (33.6%). Five clusters were identified with all clinical and laboratory findings. The first two clusters involved neuropathies, demyelinating diseases, aseptic meningitis, and movement disorder. Cluster 3 involved headache, activity markers and other SLE involvements. Idiopathic intracranial hypertension, cerebrovascular disease, cognitive dysfunction, psychiatric disorders and SLE antibodies were in the fourth, and acute confusional state was in the fifth cluster. In multivariate analysis, APA positivity; OR: 2.820, (%95CI: 1.002–7.939), P: 0,050, plasmapheresis; OR: 13.804 (%95CI: 2.785–68.432), P: 0,001, SLEDAI scores; OR: 1.115 (%95CI: (1.049–1.186), P: 0,001 were associated with increased risk for neurologic sequelae. Conclusion: We detected the prevalence of juvenile NPSLE manifestations in Turkey. We have identified five clusters that may shed light pathogenesis, treatment and prognosis of NP involvements. We also determined risk factors of neurological sequelae. Our study showed that new definitions NP involvements and sequelae for childhood period are needed