Yüksek pozitif ekspiryum sonu basıncı nedeniyle oluşan pnömomediyastinum olgusu

A 26-year-old female patient, who presented to the emergency department with chronic renal failure, general condition disturbance and dyspnea, was intubated due to low oxygen saturation. The results of the blood biochemical test were normal except for low saturation. Our case did not have any coronary artery disease or obstructive pulmonary disease. While she was undergoing the positive end-expiratory pressure (PEEP) treatment in the intensive care unit, the patient was detected to have right heart failure on her echocardiogram examination and pneumomediastinum was found on her direct radiography examination and on chest x-ray and computed tomography (CT) on the 2nd day of her hospitalization. The development of pneumomediastinum associated with PEEP for low saturation appears to be a rare phenomenon. In accompany with the findings of the case, the examination data and the literature information were prepared as a case report.Kronik böbrek yetmezliği, genel durum bozukluğu ve solunum sıkıntısı ile acil servise başvuran 26 yaşındaki kadın hasta satürasyon problemi nedeniyle entübe edildi. Satürasyon düşüklüğü dışında genel kan biyokimyasında belirgin patoloji ayırt edilmedi. Olguda koroner arter hastalığı ya da kronik obstruktif akciğer hastalığı yoktu. Yoğun bakımda, pozitif ekspiryum sonu basınç (PEEP) tedavisi altındayken, ekokardiyografi (EKO) tetkikinde olgunun sağ kalp yetmezliği olduğu ve direkt grafi tetkikinde, yatışının 2. gününde akciğer grafisinde ve bilgisayarlı tomografi (BT) tetkikinde pnömomediyastinum tespit edildi. Düşük saturasyon için yapılan pozitif expirium sonu basınç (PEEP) tedavisi altında iken pnömomediastinum gelişmesi nadir bir durumdur. Olgunun bulguları eşliğinde tetkik verileri ve literatür bilgisi olgu sunumu olarak hazırlandı

Yüksek pozitif ekspiryum sonu basıncı nedeniyle oluşan pnömomediyastinum olgusu

A 26-year-old female patient, who presented to the emergency department with chronic renal failure, general condition disturbance and dyspnea, was intubated due to low oxygen saturation. The results of the blood biochemical test were normal except for low saturation. Our case did not have any coronary artery disease or obstructive pulmonary disease. While she was undergoing the positive end-expiratory pressure (PEEP) treatment in the intensive care unit, the patient was detected to have right heart failure on her echocardiogram examination and pneumomediastinum was found on her direct radiography examination and on chest x-ray and computed tomography (CT) on the 2nd day of her hospitalization. The development of pneumomediastinum associated with PEEP for low saturation appears to be a rare phenomenon. In accompany with the findings of the case, the examination data and the literature information were prepared as a case report.Kronik böbrek yetmezliği, genel durum bozukluğu ve solunum sıkıntısı ile acil servise başvuran 26 yaşındaki kadın hasta satürasyon problemi nedeniyle entübe edildi. Satürasyon düşüklüğü dışında genel kan biyokimyasında belirgin patoloji ayırt edilmedi. Olguda koroner arter hastalığı ya da kronik obstruktif akciğer hastalığı yoktu. Yoğun bakımda, pozitif ekspiryum sonu basınç (PEEP) tedavisi altındayken, ekokardiyografi (EKO) tetkikinde olgunun sağ kalp yetmezliği olduğu ve direkt grafi tetkikinde, yatışının 2. gününde akciğer grafisinde ve bilgisayarlı tomografi (BT) tetkikinde pnömomediyastinum tespit edildi. Düşük saturasyon için yapılan pozitif expirium sonu basınç (PEEP) tedavisi altında iken pnömomediastinum gelişmesi nadir bir durumdur. Olgunun bulguları eşliğinde tetkik verileri ve literatür bilgisi olgu sunumu olarak hazırlandı

Epidemiologic and clinical characteristics of neonates with late-onset COVID-19: 1-year data of Turkish Neonatal Society

© 2022, The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.The literature on neonates with SARS-CoV-2 is mainly concerned with perinatal cases, and scanty data are available about environmentally infected neonates. To fill knowledge gaps on the course and prognosis of neonatal cases, we analyzed 1-year data from the Turkish Neonatal Society in this prospective cohort study of neonates with postnatal transmission. Data from 44 neonatal intensive care units (NICUs), of neonates with positive RT-PCR results at days 5–28 of life, were extracted from the online registry system and analyzed. Of 176 cases, most were term infants with normal birth weight. Fever was the most common symptom (64.2%), followed by feeding intolerance (25.6%), and cough (21.6%). The median length of hospitalization was 9 days, with approximately one quarter of infants receiving some type of ventilatory support. Myocarditis (5.7%) was the most common complication during follow-up. Among the clinical findings, cough (odds ratio [OR]: 9.52, 95% confidence interval [CI]: 4.17–21.71), tachypnea (OR: 26.5, 95% CI: 9.59–73.19), and chest retractions (OR: 27.5, 95% CI: 5.96–126.96) were associated with more severe clinical disease. Also, there were significant differences in the C-reactive protein level, prothrombin time (PT), partial thromboplastin time, international normalized ratio, and days in the NICU (p = 0.002, p = 0.012, p = 0.034, p = 0.008, and p < 0.001, respectively) between patients with mild-moderate and severe-critical presentations. A PT above 14 s was a significant predictor of severe/critical cases, with a sensitivity of 64% and specificity of 73%. Conclusions: Our data showed that late-onset COVID-19 infection in neonates who need hospitalization can be severe, showing associations with high rates of ventilatory support and myocarditis. Cough, tachypnea, and retractions on admission suggest a severe disease course. Trial registration: ClinicalTrials.gov identifier: NCT04401540.What is Known:• Neonatal cases of COVID-19 infection are mainly reported as perinatal COVID-19 cases.• Neonates with perinatal transmission have a mild course and favorable prognosis.What is New:• Among symptomatic neonates with late-onset COVID-19 infection, fever was the most common symptom, and almost one quarter of hospitalized cases needed some type of respiratory support. Myocarditis was the most common complication.• The presence of cough, tachypnea, retractions, and a PT above 14 s were associated with an increased risk of severe COVID-19

Managing adult patients with infectious diseases in emergency departments: international ID-IRI study

We aimed to explore factors for optimizing antimicrobial treatment in emergency departments. A single-day point prevalence survey was conducted on January 18, 2020, in 53 referral/tertiary hospitals in 22 countries. 1957 (17%) of 11557 patients presenting to EDs had infections. The mean qSOFA score was 0.37 +/- 0.74. Sepsis (qSOFA >= 2) was recorded in 218 (11.1%) patients. The mean qSOFA score was significantly higher in low-middle (1.48 +/- 0.963) compared to upper-middle (0.17 +/- 0.482) and high-income (0.36 +/- 0.714) countries ( P < 0.001). Eight (3.7%) patients with sepsis were treated as outpatients. The most common diagnoses were upper-respiratory (n = 877, 43.3%), lower-respiratory (n = 316, 16.1%), and lower-urinary (n = 201, 10.3%) infections. 1085 (55.4%) patients received antibiotics. The most-commonly used antibiotics were beta-lactam (BL) and BL inhibitors (n = 307, 15.7%), third-generation cephalosporins (n = 251, 12.8%), and quinolones (n = 204, 10.5%). Irrational antibiotic use and inappropriate hospitalization decisions seemed possible. Patients were more septic in countries with limited resources. Hence, a better organizational scheme is required

The effect of sleep disorders on quality of life in patients with epilepsy: A multicenter study from Turkey

Objective: We aimed to investigate sleep disorders in patients with epilepsy (PWE) and to investigate the effects of sleep disorders on quality of life. Methods: In our multicenter study conducted in Turkey, 1358 PWE were evaluated. The demographic and clinical data of the patients were recorded. The Insomnia Severity Index (ISI), Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI), Beck Depression Inventory (BDI), and Quality of Life in Epilepsy Inventory-10 (QOLIE-10) were administered. Results: The mean age of 1358 patients was 35.92 ± 14.11 (range, 18–89) years. Seven hundred fifty-one (55.30 %) were women. Some 12.7 % of the patients had insomnia (ISI > 14), 9.6 % had excessive daytime sleepiness (ESS > 10), 46.5 % had poor sleep quality (PSQI > 5), and 354 patients (26.1 %) had depressive symptoms (BDI > 16). The mean QOLIE-10 score was 22.82 ± 8.14 (10–48). Resistant epilepsy was evaluated as the parameter with the highest risk affecting quality of life Adjusted odds ratio (AOR = 3.714; 95 % confidence interval (CI): [2.440–5.652] < 0.001)). ISI (AOR = 1.184; 95 % CI: [1.128–1.243]; p < 0.001), ESS (AOR = 1.081; 95 % CI: [1.034–1.130]; p < 0.001), PSQI (AOR = 0.928; 95 % CI: [0.867 – 0.994]; p = 0.034), BDI (AOR = 1.106; 95 % CI: [1.084–1.129]; p < 0.001), epilepsy duration (AOR = 1.023; 95 % CI: [1.004–1.041]; p = 0.014), were determined as factors affecting quality of life. Significance: Sleep disorders are common in PWE and impair their quality of life. Quality of life can be improved by controlling the factors that may cause sleep disorders such as good seizure control, avoiding polypharmacy, and correcting the underlying mood disorders in patients with epilepsy

Push and Pull Factors of Why Medical Students Want to Leave Türkiye: A Countrywide Multicenter Study

Phenomenon: Physician immigration from other countries is increasing as developed countries continue to be desirable destinations for physicians; however, the determinants of Turkish physicians’ migration decisions are still unclear. Despite its wide coverage in the media and among physicians in Türkiye, and being the subject of much debate, there is insufficient data to justify this attention. With this study, we aimed to investigate the tendency of senior medical students in Türkiye to pursue their professional careers abroad and its related factors. Approach: This cross-sectional study involved 9881 senior medical students from 39 different medical schools in Türkiye in 2022. Besides participants’ migration decision, we evaluated the push and pull factors related to working, social environment and lifestyle in Türkiye and abroad, medical school education inadequacy, and personal insufficiencies, as well as the socioeconomic variables that may affect the decision to migrate abroad. The analyses were carried out with a participation rate of at least 50%. Findings: Of the medical students, 70.7% had emigration intentions. Approximately 60% of those want to stay abroad permanently, and 61.5% of them took initiatives such as learning a foreign language abroad (54.5%) and taking relevant exams (18.9%). Those who wanted to work in the field of Research & Development were 1.37 (95% CI: 1.22–1.54) times more likely to emigrate. The push factor that was related to emigration intention was the “working conditions in the country” (OR: 1.89, 95% CI: 1.56–2.28) whereas the “social environment/lifestyle abroad” was the mere pull factor for the tendency of emigration (OR: 1.73, 95% CI: 1.45–2.06). In addition, the quality problem in medical schools also had a significant impact on students’ decisions (OR: 2.20, 95% CI: 1.83–2.65). Insights: Although the percentage of those who want to emigrate “definitely” was at the same level as in the other developing countries, the tendency to migrate “permanently” was higher in Türkiye. Improving working conditions in the country and increasing the quality of medical faculties seem vital in preventing the migration of physicians