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Necla Dereli

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Petros Bouras-Vallianatos

National & Kapodistrian University of Athens

Duke University

Agostino Paravicini Bagliani

University of Lausanne

University of Zurich, Switzerland

Maria Pia Donato

Centre National de la Recherche Scientifique / French National Centre for Scientific Research

National Yang Ming Chiao Tung University

Irina Malkina-Pykh

Saint-Petersburg State University

Centre National de la Recherche Scientifique / French National Centre for Scientific Research

Maria Antónia Lopes

Universidade de Coimbra

André van Zundert

The University of Queensland, Australia

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Papers by Necla Dereli

Pulmonary candidiasis presenting as tumor-like shadow

Kastamonu Medical Journal, Dec 16, 2023

Can we estimate cytokine storm from initial computed tomography images of Coronavirus disease-2019 patients?

Bratislavské lekárske listy, 2021

OBJECTIVES: The present study aims to investigate whether elementary lesions detected at the time... more OBJECTIVES: The present study aims to investigate whether elementary lesions detected at the time of the diagnosis, their distribution characteristics, and CT scoring can be predictive of a cytokine storm. BACKGROUND: CT might have a prognostic predictive value beyond its diagnostic value. METHODS: Sixty-eight patients, 32 with cytokine storm and 36 without cytokine storm, were included in the study. Four different scoring methods were created according to elementary lesions, distribution and involvement rate. CT scores and demographic fi ndings of the cases were compared in the cytokine storm and non-cytokine storm groups. RESULTS: The mean age of patients was 57.72 (SD: 13.5) and 40 (58.8 %) of them were male. The cytokine storm was signifi cantly more common among male patients and patients of older age (p=0.04). The AUC values of CT score 1, CT score 2, CT score 3, and CT score 4 were as follows; 0.772 (95% CI; 0.651-0.892), 0.766 (95% CI; 0.647-0.885), 0.758 (95% CI; 0.639-8.78), and 0.760 (95% CI; 0.640-0.881), respectively. All CT scores had better predictive values in males. CONCLUSIONS: CT scoring at the time of admission can be used to predict cases that may develop cytokine storm later (Tab. 4, Fig. 2, Ref. 15).

Correction: Co-infection and ICU-acquired infection in COVID-19 ICU patients: a secondary analysis of the UNITE-COVID data set

Critical Care

Following publication of the original article [1], an error was identified in the article title: ... more

Clinical and Organizational Factors Associated With Feeding Tube Use Among Nursing Home Residents With Advanced Cognitive Impairment

JAMA: The Journal of the American Medical Association, 2003

GROWING PROPORTION OF THE approximately 4 million older US adults with Alzheimer disease or other... more GROWING PROPORTION OF THE approximately 4 million older US adults with Alzheimer disease or other dementias are now surviving to the advanced stages of their illness. Eating and swallowing problems typically develop during the terminal stages of dementias. Whether to initiate feeding tube use or to focus on comfort is one of the most challenging dilemmas facing families, clinicians, and institutions caring for these patients. 1,2 The widespread use of feeding tubes among older persons with advanced cognitive impairment in the United States 3 is concerning amid growing empirical data and expert opinion indicating that feeding tube use has no demonstrable health benefits in this population and may be associated with increased risks and discomfort. 1,2 For physician and/or institution practice to change, the factors that influence feeding tube use among individuals with advanced cognitive impairment must be understood. These influences may include the clinical characteristics of the patient, the quality of the shared decision-making process, cultural attitudes toward death and dying, and organizational features specific to the health care environment in which the patient is receiving care. The prevalence of feeding tube use varies considerably among nursing home residents with advanced dementia who are living in different facilities, 4 states, 3,5 and countries. 6 These observations suggest that broader influences, which are external to the pa

Co-infection and ICU-acquired infection in COVID-19 ICU patients: a secondary analysis of the UNITE-COVID data set

Critical Care

Background The COVID-19 pandemic presented major challenges for critical care facilities worldwid... more Background The COVID-19 pandemic presented major challenges for critical care facilities worldwide. Infections which develop alongside or subsequent to viral pneumonitis are a challenge under sporadic and pandemic conditions; however, data have suggested that patterns of these differ between COVID-19 and other viral pneumonitides. This secondary analysis aimed to explore patterns of co-infection and intensive care unit-acquired infections (ICU-AI) and the relationship to use of corticosteroids in a large, international cohort of critically ill COVID-19 patients. Methods This is a multicenter, international, observational study, including adult patients with PCR-confirmed COVID-19 diagnosis admitted to ICUs at the peak of wave one of COVID-19 (February 15th to May 15th, 2020). Data collected included investigator-assessed co-infection at ICU admission, infection acquired in ICU, infection with multi-drug resistant organisms (MDRO) and antibiotic use. Frequencies were compared by Pear...

Yoğun Bakım Ünitesinde Takip Edilen İleus Olgularının Retrospektif Değerlendirilmesi

Turkiye Klinikleri Journal of Anesthesiology Reanimation, 2014

İleus cerrahisi geçiren hastalar postoperatif takip ve bakım için sıklıkla yoğun bakım ünitesine ... more İleus cerrahisi geçiren hastalar postoperatif takip ve bakım için sıklıkla yoğun bakım ünitesine (YBÜ) kabul edilir. İleri yaşlı, komorbiditesi fazla hastalarda YBÜ izlem gerektirebilecek ve mortal seyredebilecek bir sorundur. Çalışmamızda, ileus nedeniyle opere edilen ve postoperatif YBÜ'de izlenen hastaların retrospektif değerlendirmesini yapmayı amaçladık. G Ge er re eç ç v ve e Y Yö ön nt te em ml le er r: : 2012 Ocak-2014 Ocak tarihleri arasında ileus nedeniyle opere edilen ve postoperatif YBÜ'de takip edilen hastalara ait veriler toplanmıştır. Toplam 71 olgu dâhil edilmiş, demografik verileri, ileus nedenleri, Amerikan Anestezistler Derneği (ASA), P-POSSUM, SOFA, APACHE, Glaskow koma ve Charlson komorbidite indeks skorları, anestezi yöntemleri, komorbid hastalıkları, YBÜ'de yatış süreleri ve komplikasyonlar kaydedilmiştir. B Bu ul lg gu ul la ar r: : Yaş ortalaması 71,7±11,8 yıldır. Komorbid hastalıklardan en sık görülenleri hipertansiyon ve Diabetes mellitus'tur. En sık ileus sebepleri tümör ve inguinal herniye sekonder obstrüksyondu (%22,5). Preoperatif de

Heterozigot FV Leiden Mutasyonlu Hastada Sezaryen Sonrası Gelişen Pulmoner Tromboemboli

Turkiye Klinikleri Journal of Anesthesiology Reanimation, 2013

A rare complication of Henoch-Schönlein Syndrome: gastrointestinal infarction and perforation

PubMed, Jun 1, 2012

Efeito da infusão de esmolol sobre a necessidade de anestesia no intraoperatório e analgesia, náusea e vômito no pós‐operatório em um grupo de pacientes submetidos à colecistectomia laparoscópica

Revista Brasileira De Anestesiologia, Mar 1, 2015

Conclusão: O uso de esmolol durante a manutenção da anestesia reduz significativamente a necessid... more

Causa inusual de dificultad respiratoria: hernia de Morgagni asociada con el síndrome de Down

Revista Médica Internacional sobre el Síndrome de Down, 2013

Morgagni hernia (MH) is a rare diaphragmatic hernia with 2% rate of congenital diaphragmatic hern... more Morgagni hernia (MH) is a rare diaphragmatic hernia with 2% rate of congenital diaphragmatic hernias. Is reported Down's syndrome (DS) the most common chromosomal anomaly. There is a wide range variation among individuals clinically by its characteristic features and associated systemic malformations. The coexistence of Morgagni hernia and DS is reported approximately 20% . A female patient with DS was admitted to emergency department for evaluation of recurrent pneumonia accompanied by persistent dry cough and fever. In the case the radiographic abnormality was actually found to be MH with intestinal loops in the right thorax. We report this case to notify an asymptomatic association between DS and MH.

Are We Being Informed Correctly During the Patient Transfer to the Intensive Care Units?

Türk Yoğun Bakim Derneği Dergisi, Aug 11, 2016

Colonic obstruction following percutaneous endoscopic gastrostomy placement

Endoscopy, May 23, 2012

Pulmonary edema due to mitral stenosis in pregnancy: A Case Report

Türk jinekoloji ve obstetrik derneği dergisi, 2012

Mitral stenosis is a valve disease, that creates the most trouble during pregnancy and birth proc... more Mitral stenosis is a valve disease, that creates the most trouble during pregnancy and birth process. Plasma volume increases due to sodium and water retention during pregnancy and the second trimester of pregnancy it reaches the maximum level. At the first trimester of pregnancy, normal cardiac output increases by 30 to 40% and this condition causes significant hemodynamic changes in patients with mitral stenosis. Pulmonary edema occurs rapidly with high left atrial pressure due to increase of preload. ‹t is noted that acute pulmonary edema is the primary cause on maternal mortality in pregnant women with mitral stenosis. Clinical signs are becoming evident, especially after the 12th week. Despite the best conservative treatment, maternal and infant mortality can be seen.In this case, we present a rare occurrence of pulmonary edema following dispne due to mitral stenosis in a 19 years old pregnant at 29th week of the first pregnancy.

A community acquired pneumonia case caused by Ralstonia pickettii

Mikrobiyoloji Bulteni, Apr 1, 2009

Ralstonia pickettii, formerly known as Burkholderia pickettii, is a non-fermentative gram-negativ... more Ralstonia pickettii, formerly known as Burkholderia pickettii, is a non-fermentative gram-negative bacillus. It is emerging as an opportunistic pathogen both in the hospital setting and in the environment, leading to outbreaks especially in the intensive care units. The available literature revealed two case reports of pneumonia associated with R. pickettii in adults. In this report, a case of pneumoniae due to R. pickettii, in a patient with chronic obstructive pulmonary disease was presented. Fifty-six years old male patient was admitted to the hospital with complaints of shortness of breath, cough, purulent sputum, weakness, fatigue and green colorred diarrhea lacking blood. Lung auscultation revealed decreased respiratory sounds in the right lower lobe. Laboratory findings yielded decreased arterial pH and paO2 and increased pCO2 values, while hemoglobin, hematocrite, blood urea and creatinine levels were increased. Chest X-ray showed an infiltration on right lower zone. The patient was intubated and imipenem 1 x 500 mg/day and netilmicin 1 x 80 mg/day were initiated. Deep tracheal aspirate specimen revealed gram-negative rods and leukocytes, and cultures yielded growth of non-fermentative gram-negative bacilli on blood agar and EMB agar. These bacilli were identified as R. pickettii by using VITEK 2 system (bi-oMerieux Inc, Mercy L&amp;amp;amp;amp;amp;amp;amp;amp;#39;etoil, France). Antibiotic sensitivity test performed by VITEK 2 GP system (bioMerieux Inc, Mercy L&amp;amp;amp;amp;amp;amp;amp;amp;#39;etoil, France) revealed sensitivity to ceftriaxone, imipenem/cilastatin, piperacillin/tazobactam, amikacin, gentamicin, cefoperazone-sulbactam and ciprofloxacin. Treatment with imipenem/cilastatin was continued for 14 days and the patient was completely recovered. This case was presented in order to call attention to R. pickettii as a pathogen that may cause community-acquired lower respiratory tract infection.

Combinação de levobupivacaína em dose baixa e fentanil para raquianestesia em cirurgia anorretal

Revista Brasileira De Anestesiologia, Nov 1, 2015

Three-Year Evaluation of Nosocomial Infection Rates of the ICU

Revista Brasileira De Anestesiologia, 2013

REVISTA BRASILEIRA DE ANESTESIOLOGIA Resumo Justifi cativa e objetivos: Avaliar a incidência de i... more REVISTA BRASILEIRA DE ANESTESIOLOGIA Resumo Justifi cativa e objetivos: Avaliar a incidência de infecções nosocomiais associadas aos dispositivos invasivos permite comparar as infecções associadas aos cuidados em saúde (IACS) entre as unidades de terapia intensiva (UTI) de diferentes hospitais e unidades do mesmo hospital. Material e métodos: De janeiro de 2007 a dezembro de 2010, um estudo de vigilância retrospectivo foi realizado para identifi car infecções nosocomiais, taxas de infecções relacionadas a dispositivos e agentes causadores na UTI de anestesiologia. As IACS foram defi nidas de acordo com os critérios do Centro de Controle e Prevenção de Doenças (CDC) e as infecções relacionadas aos dispositivos invasivos defi nidas de acordo com os critérios do Sistema Nacional de Vigilância de Infecções Nosocomiais (NNIS). Resultados: Durante dois anos, 939 pacientes em um universo de 7.892 pacientes/dia foram avaliados. As taxas de IACS foram de 53% em 2007, 29,15% em 2008, 28,85% em 2009 e 16,62% em 2010. A IACS mais comum foi infecção da corrente sanguínea. A taxa de infecção de tecido mole e pele foi a segunda. Entre os pacientes com infecções nosocomiais, os agentes causadores mais comuns foram Gram (-) 56,68%, Gram (+) 31,02% e candidíase 12,3%. Conclusões: A incidência de IACS na UTI de nosso hospital foi alta, em comparação com as taxas turcas globais obtidas no Refi k Saydam Center em 2007. Quando as taxas de infecções relacionadas aos dispositivos foram comparadas entre 2007 e 2008, foram maiores em 2007. A taxas de infecções relacionadas aos dispositivos em 2008 foram reduzidas abaixo da média nacional por causa das medidas de controle de infecção. Como a taxa de infecções relacionada ao cateter urinário ainda permanece alta, devemos exercer esforços contínuos para o controle das infecções.

Tres años de evaluación de las tasas de infección nosocomial en UCI

Brazilian journal of anesthesiology, 2013

Offi cial Publication of the Brazilian Society of Anesthesiology www.sba.com.br/rba/index.asp REV... more Offi cial Publication of the Brazilian Society of Anesthesiology www.sba.com.br/rba/index.asp REVISTA BRASILEIRA DE ANESTESIOLOGIA Resumen Justifi cativa y objetivos: La evaluación de la incidencia de las infecciones nosocomiales asociadas con los dispositivos invasivos, permite comparar las infecciones relacionadas con la asistencia a la sanidad (IRAS) entre las UCIs de diferentes hospitales y las unidades del mismo hospital. Material y métodos: De enero de 2007 a diciembre de 2010, un estudio de vigilancia retrospectivo fue realizado para identifi car infecciones nosocomiales, tasas de infecciones relacionadas con los dispositivos y agentes causantes en la unidad de cuidados intensivos (UCI) de anestesiología. Las IRAS se defi nieron de acuerdo con los criterios del Centro de Control y Prevención de Enfermedades (CDC) y las infecciones relacionadas con los dispositivos invasivos defi nidas de acuerdo con los criterios del Sistema Nacional de Vigilancia de Infecciones Nosocomiales (NNIS). Resultados: Durante dos años, se evaluaron 939 pacientes dentro de un universo de 7.892 pacientes/día. Las tasas de IRAS alcanzaron el umbral del 53% en 2007, 29,15% en 2008, 28,85% en 2009 y 16,62% en 2010. La IRAS más frecuente fue la infección de la corriente sanguínea. La tasa de infección de tejido suave y de la piel fue la segunda. Entre los pacientes con infecciones nosocomiales, los agentes causantes más a menudo encontrados fueron Gr (-) 56,68%, Gr (+) 31,02% y la candidiasis 12,3%. Conclusiones: La incidencia de IRAS en la UCI de nuestro hospital fue alta en comparación con las tasas turcas globales obtenidas en el Refi k Saydam Center en 2007. Cuando las tasas de infecciones relacionadas con los dispositivos se compararon entre 2007 y 2008, fueron mayores en el 2007. Las tasas de infecciones relacionadas con los dispositivos en 2008 quedaron por debajo del promedio nacional a causa de las medidas de control de infección. Como la tasa de infecciones relacionada con el catéter urinario todavía permanece alta, debemos esforzarnos más en el sentido de controlar las infecciones.

Effect of pre-emptive ketamine on sensory changes and postoperative pain after thoracotomy: comparison of epidural and intramuscular routes

BJA: British Journal of Anaesthesia, Sep 1, 2004

Background. In this study we have evaluated the efficacy of ketamine via i.m. and epidural routes... more Background. In this study we have evaluated the efficacy of ketamine via i.m. and epidural routes for the control of post-thoracotomy pain. Methods. The study was randomized, double blinded and placebo controlled. With the approval of the Faculty Ethics Committee, 60 patients undergoing elective thoracotomy were randomized into three equal groups. Group IM had i.m. ketamine 1 mg kg À1 in 2 ml plus epidural normal saline; Group EPI had epidural ketamine 1 mg kg À1 in 10 ml plus i.m. normal saline; Group C had epidural normal saline 10 ml plus i.m. normal saline 10 ml. Anaesthesia was standardized. Postoperative analgesia was maintained with epidural patient-controlled analgesia using bupivacaine and morphine. Visual analogue scale values and analgesic consumption were evaluated at 2, 4, 6, 8, 10, 12, 24 and 48 h after surgery. The areas of allodynia, pin-prick hyperalgesia and pressure hyperalgesia were measured at 48 h, and days 15 and 30 in all groups. Results. Intraoperative fentanyl requirement was significantly lower in Group EPI than Group C. The morphine and bupivacaine requirements were significantly lower in Group EPI than the other two groups in the postoperative period. There was reduced pin-prick hyperalgesia and touch allodynia in the EPI group. There were no side-effects attributable to ketamine. Conclusion. The results of the present study demonstrate that pre-emptive epidural ketamine is effective in reducing intra-and postoperative analgesic requirements, hyperalgesia and touch allodynia.

Causa inusual de destret respiratori: hèrnia de Morgagni associada amb la síndrome de Down

Unusual cause of respiratory distress: Morgagni hernia associated to Down's syndrome

Morgagni hernia (MH) is a rare diaphragmatic hernia with 2% rate of congenital diaphragmatic hern... more Morgagni hernia (MH) is a rare diaphragmatic hernia with 2% rate of congenital diaphragmatic hernias. Is reported Down's syndrome (DS) the most common chromosomal anomaly. There is a wide range variation among individuals clinically by its characteristic features and associated systemic malformations. The coexistence of Morgagni hernia and DS is reported approximately 20%. A female patient with DS was admitted to emergency department for evaluation of recurrent pneumonia accompanied by persistent dry cough and fever. In the case the radiographic abnormality was actually found to be MH with intestinal loops in the right thorax. We report this case to notify an asymptomatic association between DS and MH.

Pulmonary candidiasis presenting as tumor-like shadow

Kastamonu Medical Journal, Dec 16, 2023

Can we estimate cytokine storm from initial computed tomography images of Coronavirus disease-2019 patients?

Bratislavské lekárske listy, 2021

OBJECTIVES: The present study aims to investigate whether elementary lesions detected at the time... more OBJECTIVES: The present study aims to investigate whether elementary lesions detected at the time of the diagnosis, their distribution characteristics, and CT scoring can be predictive of a cytokine storm. BACKGROUND: CT might have a prognostic predictive value beyond its diagnostic value. METHODS: Sixty-eight patients, 32 with cytokine storm and 36 without cytokine storm, were included in the study. Four different scoring methods were created according to elementary lesions, distribution and involvement rate. CT scores and demographic fi ndings of the cases were compared in the cytokine storm and non-cytokine storm groups. RESULTS: The mean age of patients was 57.72 (SD: 13.5) and 40 (58.8 %) of them were male. The cytokine storm was signifi cantly more common among male patients and patients of older age (p=0.04). The AUC values of CT score 1, CT score 2, CT score 3, and CT score 4 were as follows; 0.772 (95% CI; 0.651-0.892), 0.766 (95% CI; 0.647-0.885), 0.758 (95% CI; 0.639-8.78), and 0.760 (95% CI; 0.640-0.881), respectively. All CT scores had better predictive values in males. CONCLUSIONS: CT scoring at the time of admission can be used to predict cases that may develop cytokine storm later (Tab. 4, Fig. 2, Ref. 15).

Correction: Co-infection and ICU-acquired infection in COVID-19 ICU patients: a secondary analysis of the UNITE-COVID data set

Critical Care

Following publication of the original article [1], an error was identified in the article title: ... more

Clinical and Organizational Factors Associated With Feeding Tube Use Among Nursing Home Residents With Advanced Cognitive Impairment

JAMA: The Journal of the American Medical Association, 2003

GROWING PROPORTION OF THE approximately 4 million older US adults with Alzheimer disease or other... more GROWING PROPORTION OF THE approximately 4 million older US adults with Alzheimer disease or other dementias are now surviving to the advanced stages of their illness. Eating and swallowing problems typically develop during the terminal stages of dementias. Whether to initiate feeding tube use or to focus on comfort is one of the most challenging dilemmas facing families, clinicians, and institutions caring for these patients. 1,2 The widespread use of feeding tubes among older persons with advanced cognitive impairment in the United States 3 is concerning amid growing empirical data and expert opinion indicating that feeding tube use has no demonstrable health benefits in this population and may be associated with increased risks and discomfort. 1,2 For physician and/or institution practice to change, the factors that influence feeding tube use among individuals with advanced cognitive impairment must be understood. These influences may include the clinical characteristics of the patient, the quality of the shared decision-making process, cultural attitudes toward death and dying, and organizational features specific to the health care environment in which the patient is receiving care. The prevalence of feeding tube use varies considerably among nursing home residents with advanced dementia who are living in different facilities, 4 states, 3,5 and countries. 6 These observations suggest that broader influences, which are external to the pa

Co-infection and ICU-acquired infection in COVID-19 ICU patients: a secondary analysis of the UNITE-COVID data set

Critical Care

Background The COVID-19 pandemic presented major challenges for critical care facilities worldwid... more Background The COVID-19 pandemic presented major challenges for critical care facilities worldwide. Infections which develop alongside or subsequent to viral pneumonitis are a challenge under sporadic and pandemic conditions; however, data have suggested that patterns of these differ between COVID-19 and other viral pneumonitides. This secondary analysis aimed to explore patterns of co-infection and intensive care unit-acquired infections (ICU-AI) and the relationship to use of corticosteroids in a large, international cohort of critically ill COVID-19 patients. Methods This is a multicenter, international, observational study, including adult patients with PCR-confirmed COVID-19 diagnosis admitted to ICUs at the peak of wave one of COVID-19 (February 15th to May 15th, 2020). Data collected included investigator-assessed co-infection at ICU admission, infection acquired in ICU, infection with multi-drug resistant organisms (MDRO) and antibiotic use. Frequencies were compared by Pear...

Yoğun Bakım Ünitesinde Takip Edilen İleus Olgularının Retrospektif Değerlendirilmesi

Turkiye Klinikleri Journal of Anesthesiology Reanimation, 2014

İleus cerrahisi geçiren hastalar postoperatif takip ve bakım için sıklıkla yoğun bakım ünitesine ... more İleus cerrahisi geçiren hastalar postoperatif takip ve bakım için sıklıkla yoğun bakım ünitesine (YBÜ) kabul edilir. İleri yaşlı, komorbiditesi fazla hastalarda YBÜ izlem gerektirebilecek ve mortal seyredebilecek bir sorundur. Çalışmamızda, ileus nedeniyle opere edilen ve postoperatif YBÜ'de izlenen hastaların retrospektif değerlendirmesini yapmayı amaçladık. G Ge er re eç ç v ve e Y Yö ön nt te em ml le er r: : 2012 Ocak-2014 Ocak tarihleri arasında ileus nedeniyle opere edilen ve postoperatif YBÜ'de takip edilen hastalara ait veriler toplanmıştır. Toplam 71 olgu dâhil edilmiş, demografik verileri, ileus nedenleri, Amerikan Anestezistler Derneği (ASA), P-POSSUM, SOFA, APACHE, Glaskow koma ve Charlson komorbidite indeks skorları, anestezi yöntemleri, komorbid hastalıkları, YBÜ'de yatış süreleri ve komplikasyonlar kaydedilmiştir. B Bu ul lg gu ul la ar r: : Yaş ortalaması 71,7±11,8 yıldır. Komorbid hastalıklardan en sık görülenleri hipertansiyon ve Diabetes mellitus'tur. En sık ileus sebepleri tümör ve inguinal herniye sekonder obstrüksyondu (%22,5). Preoperatif de

Heterozigot FV Leiden Mutasyonlu Hastada Sezaryen Sonrası Gelişen Pulmoner Tromboemboli

Turkiye Klinikleri Journal of Anesthesiology Reanimation, 2013

A rare complication of Henoch-Schönlein Syndrome: gastrointestinal infarction and perforation

PubMed, Jun 1, 2012

Efeito da infusão de esmolol sobre a necessidade de anestesia no intraoperatório e analgesia, náusea e vômito no pós‐operatório em um grupo de pacientes submetidos à colecistectomia laparoscópica

Revista Brasileira De Anestesiologia, Mar 1, 2015

Conclusão: O uso de esmolol durante a manutenção da anestesia reduz significativamente a necessid... more

Causa inusual de dificultad respiratoria: hernia de Morgagni asociada con el síndrome de Down

Revista Médica Internacional sobre el Síndrome de Down, 2013

Morgagni hernia (MH) is a rare diaphragmatic hernia with 2% rate of congenital diaphragmatic hern... more Morgagni hernia (MH) is a rare diaphragmatic hernia with 2% rate of congenital diaphragmatic hernias. Is reported Down's syndrome (DS) the most common chromosomal anomaly. There is a wide range variation among individuals clinically by its characteristic features and associated systemic malformations. The coexistence of Morgagni hernia and DS is reported approximately 20% . A female patient with DS was admitted to emergency department for evaluation of recurrent pneumonia accompanied by persistent dry cough and fever. In the case the radiographic abnormality was actually found to be MH with intestinal loops in the right thorax. We report this case to notify an asymptomatic association between DS and MH.

Are We Being Informed Correctly During the Patient Transfer to the Intensive Care Units?

Türk Yoğun Bakim Derneği Dergisi, Aug 11, 2016

Colonic obstruction following percutaneous endoscopic gastrostomy placement

Endoscopy, May 23, 2012

Pulmonary edema due to mitral stenosis in pregnancy: A Case Report

Türk jinekoloji ve obstetrik derneği dergisi, 2012

Mitral stenosis is a valve disease, that creates the most trouble during pregnancy and birth proc... more Mitral stenosis is a valve disease, that creates the most trouble during pregnancy and birth process. Plasma volume increases due to sodium and water retention during pregnancy and the second trimester of pregnancy it reaches the maximum level. At the first trimester of pregnancy, normal cardiac output increases by 30 to 40% and this condition causes significant hemodynamic changes in patients with mitral stenosis. Pulmonary edema occurs rapidly with high left atrial pressure due to increase of preload. ‹t is noted that acute pulmonary edema is the primary cause on maternal mortality in pregnant women with mitral stenosis. Clinical signs are becoming evident, especially after the 12th week. Despite the best conservative treatment, maternal and infant mortality can be seen.In this case, we present a rare occurrence of pulmonary edema following dispne due to mitral stenosis in a 19 years old pregnant at 29th week of the first pregnancy.

A community acquired pneumonia case caused by Ralstonia pickettii

Mikrobiyoloji Bulteni, Apr 1, 2009

Ralstonia pickettii, formerly known as Burkholderia pickettii, is a non-fermentative gram-negativ... more Ralstonia pickettii, formerly known as Burkholderia pickettii, is a non-fermentative gram-negative bacillus. It is emerging as an opportunistic pathogen both in the hospital setting and in the environment, leading to outbreaks especially in the intensive care units. The available literature revealed two case reports of pneumonia associated with R. pickettii in adults. In this report, a case of pneumoniae due to R. pickettii, in a patient with chronic obstructive pulmonary disease was presented. Fifty-six years old male patient was admitted to the hospital with complaints of shortness of breath, cough, purulent sputum, weakness, fatigue and green colorred diarrhea lacking blood. Lung auscultation revealed decreased respiratory sounds in the right lower lobe. Laboratory findings yielded decreased arterial pH and paO2 and increased pCO2 values, while hemoglobin, hematocrite, blood urea and creatinine levels were increased. Chest X-ray showed an infiltration on right lower zone. The patient was intubated and imipenem 1 x 500 mg/day and netilmicin 1 x 80 mg/day were initiated. Deep tracheal aspirate specimen revealed gram-negative rods and leukocytes, and cultures yielded growth of non-fermentative gram-negative bacilli on blood agar and EMB agar. These bacilli were identified as R. pickettii by using VITEK 2 system (bi-oMerieux Inc, Mercy L&amp;amp;amp;amp;amp;amp;amp;amp;#39;etoil, France). Antibiotic sensitivity test performed by VITEK 2 GP system (bioMerieux Inc, Mercy L&amp;amp;amp;amp;amp;amp;amp;amp;#39;etoil, France) revealed sensitivity to ceftriaxone, imipenem/cilastatin, piperacillin/tazobactam, amikacin, gentamicin, cefoperazone-sulbactam and ciprofloxacin. Treatment with imipenem/cilastatin was continued for 14 days and the patient was completely recovered. This case was presented in order to call attention to R. pickettii as a pathogen that may cause community-acquired lower respiratory tract infection.

Combinação de levobupivacaína em dose baixa e fentanil para raquianestesia em cirurgia anorretal

Revista Brasileira De Anestesiologia, Nov 1, 2015

Three-Year Evaluation of Nosocomial Infection Rates of the ICU

Revista Brasileira De Anestesiologia, 2013

REVISTA BRASILEIRA DE ANESTESIOLOGIA Resumo Justifi cativa e objetivos: Avaliar a incidência de i... more REVISTA BRASILEIRA DE ANESTESIOLOGIA Resumo Justifi cativa e objetivos: Avaliar a incidência de infecções nosocomiais associadas aos dispositivos invasivos permite comparar as infecções associadas aos cuidados em saúde (IACS) entre as unidades de terapia intensiva (UTI) de diferentes hospitais e unidades do mesmo hospital. Material e métodos: De janeiro de 2007 a dezembro de 2010, um estudo de vigilância retrospectivo foi realizado para identifi car infecções nosocomiais, taxas de infecções relacionadas a dispositivos e agentes causadores na UTI de anestesiologia. As IACS foram defi nidas de acordo com os critérios do Centro de Controle e Prevenção de Doenças (CDC) e as infecções relacionadas aos dispositivos invasivos defi nidas de acordo com os critérios do Sistema Nacional de Vigilância de Infecções Nosocomiais (NNIS). Resultados: Durante dois anos, 939 pacientes em um universo de 7.892 pacientes/dia foram avaliados. As taxas de IACS foram de 53% em 2007, 29,15% em 2008, 28,85% em 2009 e 16,62% em 2010. A IACS mais comum foi infecção da corrente sanguínea. A taxa de infecção de tecido mole e pele foi a segunda. Entre os pacientes com infecções nosocomiais, os agentes causadores mais comuns foram Gram (-) 56,68%, Gram (+) 31,02% e candidíase 12,3%. Conclusões: A incidência de IACS na UTI de nosso hospital foi alta, em comparação com as taxas turcas globais obtidas no Refi k Saydam Center em 2007. Quando as taxas de infecções relacionadas aos dispositivos foram comparadas entre 2007 e 2008, foram maiores em 2007. A taxas de infecções relacionadas aos dispositivos em 2008 foram reduzidas abaixo da média nacional por causa das medidas de controle de infecção. Como a taxa de infecções relacionada ao cateter urinário ainda permanece alta, devemos exercer esforços contínuos para o controle das infecções.

Tres años de evaluación de las tasas de infección nosocomial en UCI

Brazilian journal of anesthesiology, 2013

Offi cial Publication of the Brazilian Society of Anesthesiology www.sba.com.br/rba/index.asp REV... more Offi cial Publication of the Brazilian Society of Anesthesiology www.sba.com.br/rba/index.asp REVISTA BRASILEIRA DE ANESTESIOLOGIA Resumen Justifi cativa y objetivos: La evaluación de la incidencia de las infecciones nosocomiales asociadas con los dispositivos invasivos, permite comparar las infecciones relacionadas con la asistencia a la sanidad (IRAS) entre las UCIs de diferentes hospitales y las unidades del mismo hospital. Material y métodos: De enero de 2007 a diciembre de 2010, un estudio de vigilancia retrospectivo fue realizado para identifi car infecciones nosocomiales, tasas de infecciones relacionadas con los dispositivos y agentes causantes en la unidad de cuidados intensivos (UCI) de anestesiología. Las IRAS se defi nieron de acuerdo con los criterios del Centro de Control y Prevención de Enfermedades (CDC) y las infecciones relacionadas con los dispositivos invasivos defi nidas de acuerdo con los criterios del Sistema Nacional de Vigilancia de Infecciones Nosocomiales (NNIS). Resultados: Durante dos años, se evaluaron 939 pacientes dentro de un universo de 7.892 pacientes/día. Las tasas de IRAS alcanzaron el umbral del 53% en 2007, 29,15% en 2008, 28,85% en 2009 y 16,62% en 2010. La IRAS más frecuente fue la infección de la corriente sanguínea. La tasa de infección de tejido suave y de la piel fue la segunda. Entre los pacientes con infecciones nosocomiales, los agentes causantes más a menudo encontrados fueron Gr (-) 56,68%, Gr (+) 31,02% y la candidiasis 12,3%. Conclusiones: La incidencia de IRAS en la UCI de nuestro hospital fue alta en comparación con las tasas turcas globales obtenidas en el Refi k Saydam Center en 2007. Cuando las tasas de infecciones relacionadas con los dispositivos se compararon entre 2007 y 2008, fueron mayores en el 2007. Las tasas de infecciones relacionadas con los dispositivos en 2008 quedaron por debajo del promedio nacional a causa de las medidas de control de infección. Como la tasa de infecciones relacionada con el catéter urinario todavía permanece alta, debemos esforzarnos más en el sentido de controlar las infecciones.

Effect of pre-emptive ketamine on sensory changes and postoperative pain after thoracotomy: comparison of epidural and intramuscular routes

BJA: British Journal of Anaesthesia, Sep 1, 2004

Background. In this study we have evaluated the efficacy of ketamine via i.m. and epidural routes... more Background. In this study we have evaluated the efficacy of ketamine via i.m. and epidural routes for the control of post-thoracotomy pain. Methods. The study was randomized, double blinded and placebo controlled. With the approval of the Faculty Ethics Committee, 60 patients undergoing elective thoracotomy were randomized into three equal groups. Group IM had i.m. ketamine 1 mg kg À1 in 2 ml plus epidural normal saline; Group EPI had epidural ketamine 1 mg kg À1 in 10 ml plus i.m. normal saline; Group C had epidural normal saline 10 ml plus i.m. normal saline 10 ml. Anaesthesia was standardized. Postoperative analgesia was maintained with epidural patient-controlled analgesia using bupivacaine and morphine. Visual analogue scale values and analgesic consumption were evaluated at 2, 4, 6, 8, 10, 12, 24 and 48 h after surgery. The areas of allodynia, pin-prick hyperalgesia and pressure hyperalgesia were measured at 48 h, and days 15 and 30 in all groups. Results. Intraoperative fentanyl requirement was significantly lower in Group EPI than Group C. The morphine and bupivacaine requirements were significantly lower in Group EPI than the other two groups in the postoperative period. There was reduced pin-prick hyperalgesia and touch allodynia in the EPI group. There were no side-effects attributable to ketamine. Conclusion. The results of the present study demonstrate that pre-emptive epidural ketamine is effective in reducing intra-and postoperative analgesic requirements, hyperalgesia and touch allodynia.

Causa inusual de destret respiratori: hèrnia de Morgagni associada amb la síndrome de Down

Unusual cause of respiratory distress: Morgagni hernia associated to Down's syndrome

Morgagni hernia (MH) is a rare diaphragmatic hernia with 2% rate of congenital diaphragmatic hern... more Morgagni hernia (MH) is a rare diaphragmatic hernia with 2% rate of congenital diaphragmatic hernias. Is reported Down's syndrome (DS) the most common chromosomal anomaly. There is a wide range variation among individuals clinically by its characteristic features and associated systemic malformations. The coexistence of Morgagni hernia and DS is reported approximately 20%. A female patient with DS was admitted to emergency department for evaluation of recurrent pneumonia accompanied by persistent dry cough and fever. In the case the radiographic abnormality was actually found to be MH with intestinal loops in the right thorax. We report this case to notify an asymptomatic association between DS and MH.