The colonization rate of Candida spp. reaches up to 80% in patients who reside in intensive care units (ICUs) more than a week, and the mean rate of development of invasive disease is 10% in colonized patients. Since invasive candidiasis (IC) in ICU patients presents with septic shock and high mortality rate, rapid diagnosis and treatment are crucial. The aim of this study was to assess the relationship between invasive infection and the determination of Candida colonization index (CI) and Candida score (CS) in patients admitted to ICU who are at high risk for IC and likely to benefit from early antifungal therapy. A total of 80 patients (34 female, 46 male; age range: 12-92 years, mean age: 69.57 ± 16.30) who were in ICU over seven days or longer of Anesthesia Department of Kayseri Education and Research Hospital between April, 2014 and July, 2015 were included in the study. None of the patients were neutropenic. After admission, throat, nose, skin (axillary region), urine, rectal swab and blood cultures have been collected weekly beginning from day zero. Isolation and identification of Candida strains were performed by using conventional mycological methods. CI was calculated as the ratio of the number of culture-positive distinct body sites (except blood culture) to the total number of body sites cultured. CI> 0.2 was considered as fungal colonization, while CI≥ 0.5 as intensive colonization. CS value was calculated according to the components including total parenteral nutrition (TPN) (plus 0.908 points), surgery (plus 0.907 points), colonization in multiple areas (plus 1.112) and severe sepsis (plus 2.038 points), and cut-off value for CS was accepted as >2.5. In our study, overall 1009 cultures (mean: 13 cultures per patient) were taken from 80 patients, and yeast growth was detected in 365 (36.2%) of them. Accordingly, among 68 (85%) of 80 patients included, in at least one sample, yeast growth was determined. No yeast growth was observed in the blood cultures. Of 365 yeast-positive cultures, C.albicans was isolated from 184 (50.4%), C.glabrata from 66 (18%), C.parapsilosis from 42 (11.5%), C.tropicalis from 12 (3.3%), C.kefyr from three (0.8%), and C.krusei from one (0.3%) samples, whereas six (1.6%) samples yielded other yeasts (3 Saprochaete capitata, 3 Trichosporon spp.) and 51 (13.9%) samples yielded multiple yeast growth. The highest colonization rates were detected in rectal swabs (27.4%), urine (23.3%) and throat (22.5%) samples. CI value was found as >0.2 in 65% (52/80), and ≥0.5 in 25% (20/80) of the patients, whereas CS value was >2.5 in only 2.5% (2/80) of the patients. In the statistical evaluation, significant correlations were found between fungal colonization (CI> 0.2) and gender (p=0.032) and length of stay in ICU (p=0.004), and between intensive colonization (CI≥ 0.5) and gender (p=0.008) and age (p=0.012). However, the correlation between Candida colonization and the presence of underlying diseases, APACHE II score, Glasgow coma scale, invasive procedures, use of extended-spectrum antibi...

Transfusion-related acute lung injury (TRALI) is related to the transfusion of blood components. Typically, it is a clinical syndrome, characterized by the sudden onset of dyspnea, hypoxemia and bilateral non-cardiogenic pulmonary edema. A 83-year-old female patient with a history of AML developed TRALI after receiving 6 units of platelets. TRALI symptoms was started 10 min later the transfusion. AML is a risky group for TRALI. While giving transfusion to the risky groups of TRALI one must be more careful. The mortality rate caused by TRALI will decrease if the patient who is thought to have TRALI or who has bilateral pulmonary edema without any other reason showing the existance of TRALI is given ventilatory support at the right time.

Propofol hızlı etkili, kısa etki süreli ve nöroprotektif özelliklerinden dolayı nöroşirürji hastalarında yoğun bakımda sedasyon amaçlı kullanılmaktadır. Özellikle 3 yaş altında ki pediatrik vakalarda, uzun süreli yüksek doz kullanımına bağlı gelişen propofol infüzyon sendromu (PRIS) hayatı tehdit eden bir durumdur. Kafa travması PRIS için risk faktörüdür. Kalp ve böbrek yetmezliği, hipotansiyon, aritmi, metabolik asidoz, hiperkalemi, rabdomiyoliz, yeşil veya kırmızı idrar gibi klinik ve labroratuvar bulgularıyla karşımıza çıkar. Erken tanı, infüzyonun kesilmesi ve semptomatik destek tedavisiyle hasta bu ölümcül tablodan kurtulabilir. Biz bu yazımızda 14 yaşındaki genç hastada kafa travması sonrası düşük dozda gelişen bir propofol infüzyon sendromu olgusunu grafiksel bir zaman çizelgesi eşliğinde sunuyoruz. PRIS'e dair ilk bulgu infüzyonun 60. saatinde idrarın yeşil renge bürünmesiydi. Sonraki 24 saat içerisinde ciddi rabdomiyoliz, bradikardi ve solunum yetmezliği bulguları gelişti. Buna rağmen propofolün kesilmesi ve destek tedavisiyle hasta 48 saat içerisinde hızla ve sekelsiz iyileşti. Bu olgu gösteriyor ki, yalnızca erken çocukluk yaşlarında ve yüksek dozda değil ileri yaşlarda ve düşük dozlarda kullanılırken de PRIS gelişebilir. Tüm monitörize edilen parametreler henüz normal iken tıbbi personeli ilk uyaran bulgu idrarın yeşil renge bürünmesi olabilir.