Yusuf Savran

Increased Prevalence of M694V in Patients With Ankylosing Spondylitis Additional Evidence for a Link With Familial Mediterranean Fever

OBJECTIVE To assess whether there is a statistically significant difference in the frequency of common MEFV allele variants in patients with ankylosing spondylitis (AS) as compared with control patients with rheumatoid arthritis (RA) and with healthy control subjects. METHODS Sixty-two patients with AS, 50 healthy control subjects, and 46 patients with RA were assessed for the presence of MEFV variants. Exon 10 was analyzed by direct sequencing. E148Q was analyzed by restriction endonuclease enzyme digestion (REED) or by direct sequencing when REED analysis failed. RESULTS The allele frequency of all MEFV variants in the AS group was significantly higher than that in the pooled control group of healthy subjects plus RA patients (15.3% versus 6.8%; P = 0.021). M694V was the only variant that was significantly more common in the AS group than in the combined or individual control groups (P = 0.026 for AS patients versus healthy controls, P = 0.046 for AS patients versus RA patient controls, and P = 0.008 for AS patients versus healthy and RA patient control groups). The carriage rate of M694V was also significantly higher in the AS patient group than in the combined control group (odds ratio 7.0, P = 0.014). Neither M694V nor any other MEFV variant showed a correlation with most of the disease-related measures examined. CONCLUSION We found an increased frequency of MEFV variants in AS patients as compared with healthy controls and with RA patient controls. This was primarily due to the presence of M694V. The roles of other exon 10 variants, as well as the relationship between the variant status and the severity and clinical course of the disease, need to be explored in further studies that include sufficiently large sample sizes.

Mortality Related Risk Factors in High-Risk Pulmonary Embolism in the ICU

Introduction. We sought to identify possible risk factors associated with mortality in patients with high-risk pulmonary embolism (PE) after intensive care unit (ICU) admission. Patients and Methods. PE patients, diagnosed with computer tomography pulmonary angiography, were included from two ICUs and were categorized into groups: group 1 high-risk patients and group 2 intermediate/low-risk patients. Results. Fifty-six patients were included. Of them, 41 (73.2%) were group 1 and 15 (26.7%) were group 2. When compared to group 2, need for vasopressor therapy (0 vs 68.3%; p < 0.001) and need for invasive mechanical ventilation (6.7 vs 36.6%; p = 0.043) were more frequent in group 1. The treatment of choice for group 1 was thrombolytic therapy in 29 (70.7%) and anticoagulation in 12 (29.3%) patients. ICU mortality for group 1 was 31.7% (n = 13). In multivariate logistic regression analysis, APACHE II score >18 (OR 42.47 95% CI 1.50–1201.1), invasive mechanical ventilation (OR 30.10 95% CI 1.96–463.31), and thrombolytic therapy (OR 0.03 95% CI 0.01–0.98) were found as independent predictors of mortality. Conclusion. In high-risk PE, admission APACHE II score and need for invasive mechanical ventilation may predict death in ICU. Thrombolytic therapy seems to be beneficial in these patients.

Approach to the Elderly Patient with Delirium: The Intensive Care Specialist’s Perspective

Delirium in the intensive care unit is a common syndrome and has detrimental effects on morbidity, mortality, cost, length of mechanical ventilation, length of intensive care unit and hospital stay, and cognitive functions in the elderly patients. Preventing delirium is more feasible than treatment. Identifying the patients who are at risk for developing delirium and screening the patients for delirium with a valid screening tool in the intensive care unit are important steps to combat delirium. Management of pain, rational use of sedo-analgesia, improving sleep quality, early mobilization, daily sedation interruption, awakening and protocolized weaning trials, and modifying the preventable risk factors related with delirium will improve outcomes of elderly patient in intensive care units.

Pneumocephalus in a patient with multiple stab wounds

Pneumocephalus is a complication of trauma to the chest and many iatrogenic interventions. It may arise due to systemic air embolism or retrograde cerebral venous air embolism which is an extremely rare complication. We report a 26-years-old female patient who presented to the Emergency Department suffering of multiple stab wounds. She was in a state of shock and after first aid and evaluation she was operated successfully. In the early postoperative period generalized tonic clonic convulsions were observed following cardiopulmonary resuscitation due to sudden cardiovascular collapse. Brain computerized tomography demonstrated free air in intracranial and extracranial venous structures. Pneumocephalus was diagnosed which may be due to a wide spectrum of etiologies including thorax or spinal stab wounds, tube thoracostomy, cardiopulmonary resuscitation or even central venous catheterization. Unfortunately, the patient ended up with brain death despite all effort. In conclusion, we recommend physicians to be aware of this catastrophic complication while taking care of patients with stab wounds.

Severe allergic reaction to human insulin in the patient with diabetic ketoacidosis

Diabetic ketoacidosis (DKA) is an acute and major life-threatening complication of diabetes mellitus. Fluid resuscitation, insulin therapy, and electrolyte replacement are essential for DKA treatment. Rarely, life threatening allergic reactions might develop in a patient treated with insulin. If anaphylaxis develops after insulin, the DKA treatment options are restricted. A limited number of case reports have been reported in patients with severe anaphylactic reactions to human insulin who were then treated with synthetic insulin analogues. We present a case of a 45-year-old male patient with allergic reactions to human insulin. The patient was successfully treated with insulin aspart and hemodialysis.

Factors impact on insufficient nutrition and effects of timely adequate nutrition support on patient outcomes in adult intensive care patients

Most of the studies comparing effects of enteral and parenteral nutrition on morbidity and mortality have been performed on surgery patient groups or in mixed intensive care unit patients. Numbers of studies performed in medical intensive care units are limited and they all include few number of patients.

Evaluation of the factors affecting the prognosis of patients with solid tumors and hematologic malignancies in the intensive care unit

Methods This study included patients who were hospitalized in Dokuz Eylul University Hospital Internal Medicine Intensive Care Unit for more than 24 hours during January 2012-December 2013 interval. The patients were divided into three groups; patients with solid tumors, patients with hematologic malignancies, and patiens without cancer. Their data was analyzed retrospectively. All patients ́ data (demographic data, organ failure, comorbid diseases, critical diseases, presence of infection, immunsupressive treatments within the last month) were recorded at the time of admittance.Additionally presence of remission, history of bone marrow transplantation, previous treatments, presence of neutropenia of patients with solid tumors and hematologic malignancies were also recorded. Results Mortality rate in intensive care unit was found to be %46.0 in general, %68.6 in patients with solid tumor, %53.0 in patients with hematologic malignancy, and % 39.8 in the control group (n = 512; solid tumor = 89, hematologic malignancy = 49, control group = 374). The mortality rate was especially high among patients with solid tumors. In the logistic regression model, APACHE II score and the need of invasive mechanical ventilation at the time of admission to intensive care unit were found as independent risk factors for increased mortality. In addition, the need of renal replacement therapy at the time of admission to intensive care unit was found as an independent risk factor for increased mortality among the control group.

P01-021 – Macrophage migration inhibitory factory in FMF

Familial Mediterranean Fever (FMF) is an autoinflammatory disorder characterized by recurrent, inflammatory, self-limited episodes of fever and serositis. Neutrophils are one of the key players in the pathophysiology of FMF. Macrophage migration inhibitory factor (MIF) is a pleiotropic cytokine involved in several inflammatory processes including innate and adaptive immune responses . In addition, MIF has been shown to regulate trafficking of inflammatory cells includingneutrophis to the sites of inflammation. Because its association with innate immunity, leukocyte trafficking, and inflammation MIF may be considered as an attractive cytokine in the pathogenesis of FMF.

THU0462 Increased Oxidative Stress and Macrophage Migration Inhibitory Factor in Patients with Familial Mediterranean Fever

Background Familial Mediterranean fever (FMF) is an autoinflammatory disorder characterized by recurrent, inflammatory, self-limited episodes of fever and serositis. Neutrophils are one of the key players in the pathophysiology of FMF. Macrophage migration inhibitory factor (MIF) is a pleiotropic cytokine involved in several inflammatory processes including innate and adaptive immune responses. In addition, MIF has been shown to regulate trafficking of inflammatory cells including neutrophils to the sites of inflammation. Because its association with innate immunity, leukocyte trafficking, and inflammation MIF may be considered as an attractive cytokine in the pathogenesis of FMF. In recent years, increasing attention has been focused on the role of oxidative stress in the pathogenesis of inflammatory rheumatic diseases. As neutrophils are one of the major sources for free radicals some researchers studied oxidative stress in FMF. Objectives In this study we aimed to investigate MIF levels and its relationship with oxidative stress and M694V mutations in patients with FMF. Methods Fifty one unrelated attack free FMF patients (14 M and 27 F, 32.8±8.7 years) and 30 healthy controls (16 M and 14 F, 32.7±7 years) were included in the study. Serum MIF were studied and allele frequency of M694V was calculated. Serum total oxidant status (TOS) and total anti-oxidant status (TAS) were also studied. Results Age, sex distribution, anthropometrical indices, smoking status, serum lipids and TAS were similar between patients and controls. However; CRP, ESR, MIF, and TOS were significantly higher in the patients’ group. Comparison of patients with and without M694V mutation revealed that MIF and TOS levels were not different between the groups. Regression analysis showed that none of the variables including disease duration, CRP, ESR, TOS, TAS and BMI were predicting MIF concentrations (P > 0.05) Conclusions We found increased concentrations of MIF and oxidative stress in patients with FMF. Increased MIF levels were significantly correlated with oxidative stress and its levels were independent from the inflammatory activity. M694V mutations seem no effect on MIF and oxidative stress. Disclosure of Interest None Declared