Background/Aim: It has been reported that the prognostic nutritional index (PNI) is ), an immunonutritional index, associated with poor prognosis, especially in cardiovascular and malignant diseases. However, the clinical significance of PNI in intensive care (ICU) patients remains unclear. In this study, we aimed to measure the predictive value of the PNI in predicting mortality in patients hospitalized in the ICU. Methods: A total of 80 patients hospitalized in the internal medicine ICU of our hospital between January 2021 and September 2021 were included in this observational cohort study. The patients' demographic characteristics, comorbidities, laboratory parameters, need for and duration of mechanical ventilation, length of stay in ICU, and mortality rates were retrospectively analyzed. The patients were divided into two groups according to their survival; the first group comprised of survivors while the second group comprised of those who died in the ICU. The two groups were compared in terms of all variables. Results: The mean age of all subjects included in the study was 63 (18.2) years and 50% (n=40) were female and 50% (n=40) were male. When patients are grouped as survivors and non-survivors, the mean age and sex distribution were similar (P=0.23, P=0.27, respectively). The median follow-up period of the patients was 5 (IQR 3-11) days and the mortality rate was 38.7% (n=31). Those in the non-survivor group had higher APACHE II and SOFA scores (P=0.02, P<0.001, respectively), and a lower PNI level (P=0.01). In the multivariate regression analysis, PNI value [OR: 1.210 (95%CI: 1.048-1.396) P=0.009] was the negative independent risk factor and SOFA score [OR: 1.697 (95%CI: 1.201-2.398) P=0.03] was a positive independent risk factor. Conclusion: Despite our small cohort, we believe our findings corroborate our hypothesis that as a simple and inexpensive test, PNI is a useful biomarker to assess mortality risk in ICU patients.

The most common cause of adrenocorticotropic hormone (ACTH)-dependent Cushing’s syndrome is a benign ACTH-producing pituitary tumour or, less frequently, ectopic ACTH production from non-pituitary tumours. Ectopic ACTH syndrome occurs more commonly in men and usually presents after 40 years. It is most commonly associated with small cell lung cancer. Although this syndrome is associated with severe hypercortisolemia, some findings of Cushing’s syndrome, such as central obesity, may not be observed due to underlying malignant diseases. In these cases, rapid metabolic disruption, anorexia, myopathy, glucose intolerance, hypokalemic alkalosis, and hyperpigmentation accompany the patients’ clinical condition. In the current case report, we aimed to emphasize that ectopic ACTH syndrome should be kept in mind in the differential diagnosis, especially in the presence of hypokalemia accompanying hypertension and proximal muscle weakness, if the patient also has progressive weight loss.

Aim: Albuminuria is a direct consequence of renal glomerular injury and increases with glomerular dysfunction. Spot urine albumin/creatinine (Alb/Cr) ratio is a reasonable surrogate for 24-hour urine albumin excretion rate and certainly not without limitations. It is known that renal function can be affected following contrast agent administration. The aim of our study is to assess the changes in Alb/Cr ratio in spot urine before and after contrast agents in patients undergoing computed tomography (CT) scanning. Material and Method:The present study included 103 hospitalized patients aged between 18 and 75 years, who underwent contrast-enhanced CT scanning for any reason and did not develop contrast-induced nephropathy (CIN). We compared the values of Alb/Cr ratio at the 6th, 12th, 24th, 48th, and 72nd hours after the procedure (post-procedure time) with the values at pre-procedure time. Results:The median age of the patients were 61 years. It has been observed that there is no significant increased in microalbuminuria after the use of contrast media. When the patients were evaluated for the albuminuria level before the procedure, it has been seen that 73 patients (70.9%) had an Alb/Cr ratio of <30 mg/g (group-1) and 30 patients (29.1%) had an Alb/Cr ratio of ≥30 mg/g (group-2). In group 1, it has been observed that the Alb/Cr ratios at the post-procedure 6th, 12th, 24th, and 48th hours were statistically significantly higher than the value at pre-procedure time. In group 2, it has been observed that Alb/Cr ratio values at all post-procedure time except the 24th hour were statistically significantly lower than the values at the pre-procedure time. Conclusion: It should be considered that there might be changes in Alb/Cr ratio even without developing significant complications such as CIN in patients exposed to contrast medium.

Hantaviruses are single-stranded RNA viruses. They are transmitted to humans by rodents and insectivore hosts. Some Hantavirus subtypes are the causative agents of haemorrhagic fever with renal syndrome (HFRS), which is characterized by fever, thrombocytopenia, and acute kidney injury. Hantavirus infection is diffi cult to diagnose due to its non-specifi c clinical symptoms. Causes of acalculous cholecystitis are severe trauma or burn, surgery, long-term starvation and some viral infections. It is very rare for Hantavirus to cause acute acalculous cholecystitis. The treatment of acute acalculous cholecystitis is usually directed towards its symptoms. A 22-year-old male forest worker was admitted to our emergency outpatient clinic with the complaints of fatigue, oliguria, fever, abdominal pain and vomiting. After the clinical and laboratory examinations, HFRS and acute cholecystitis secondary to Hantavirus infection were diagnosed. The patient's condition and clinical fi ndings improved after supportive treatment. Hantavirus infection should be considered in patients with acute kidney injury, cholecystitis and thrombocytopenia (Fig. 2, Ref. 10).

Rare infections, known as signal infections might be pathognomonic for patients with diabetes mellitus. A 55-year-old man without a significant medical history was admitted to our hospital with polyuria, polydipsia, dysuria, fever, chills and weight loss for the last month. A laboratory investigation showed leukocytosis and, elevated levels of C-reactive protein, sedimentation rate, blood glucose, and HbA1c. The patient was hospitalized in the internal medicine service and started intensive insulin therapy with intravenous saline infusion. The patient's fever and chills were not improved despite ceftriaxone treatment for three days. Ceftriaxone-resistant, imipenem-sensitive E. coli was grown in the blood cultures, so ceftriaxone was stopped and imipenem plus cilastatin combination was started. Detailed physical examination of the patient for fever etiology showed severe swelling in the perineal region. Superficial and scrotal ultrasonography and then pelvic magnetic resonance imaging revealed corpus spongiosum abscess. The perineal region was punctured and numerous Gram-negative bacilli and polymorphonuclear leukocytes were seen in the gram stain. Drainage catheter was inserted into the corpus spongiosum. Blood sugar levels were regulated and the patient was discharged after the antibiotic treatment was completed. As in our case, signal infections should be kept in mind especially in patients admitted with new onset of diabetes mellitus and persistent fever. A detailed physical examination should be performed in these patients and atypical areas like perineum should be carefully examined.