Background/aim: While C-reactive protein (CRP) is a well-studied marker for predicting treatment response and mortality in sepsis, it was aimed to assess the efficacy of the neutrophil lymphocyte ratio (NLR) as a predictor of mortality and treatment response in sepsis patients in the intensive care unit (ICU). Materials and methods:In this retrospective cross-sectional study, sepsis patients were divided according to the presence of septic shock on the 1st day of ICU stay, and then subgrouped according to mortality. Patient demographics, acute physiologic and chronic health evaluation II and sequential organ failure assessment scores, NLR and CRP (on the 1st, 3rd, and last day in the ICU), microbiology data, antibiotic responses, ICU data, and mortality were recorded. Receiver operating characteristic (ROC) curves for the area under curve (AUC) were calculated for the inflammatory markers and ICU severity scores for mortality. Results:Of the 591 (65% male) enrolled patients, 111 (18.8%) were nonsurvivors with shock, 117 (19.8%) were survivors with shock, 330 (55.8%) were survivors without shock, and 33 (5.6%) were nonsurvivors without shock. On the 1st day of ICU stay, the NLR and CRP were similar in all of the groups. On the 3rd day of antibiotic response, the NLR was increased (11.8) in the nonresponsive patients when compared with the partially responsive (11.0) and responsive (8.5) patients. If the NLR was ≥15 on the 3rd day, the mortality odds ratio was 6.96 (CI: 1.4-34.1, P < 0.017). The NLR and CRP on the 1st, 3rd, and last day of ICU stay (0.52, 0.58, 0.78 and 0.56, 0.70, 0.78, respectively) showed a similar increasing trend for mortality. Conclusion:The NLR can predict mortality and antibiotic responsiveness in ICU patients with sepsis and septic shock. If the NLR is >15 on the 3rd day of postantibiotic initiation, the risk of mortality is high and treatment should be reviewed carefully.

SummaryObjectives: In this article we aimed to evaluate the clinical, electroencephalographic and socio-demographic features in patients with juvenile myoclonic epilepsy (JME) and investigate the reasons for the delay in diagnosis. Methods: We evaluated 37 patients with JME. Epilepsy onset, seizure type, antiepileptic drugs, electroencephalographic and radiologic findings were determined. Results: Twenty-seven female (72.9%), and 10 (27.1%) male patients were included. Mean age of patients was 22.8 (9-62), the onset of seizures ranged from 7 to 18 years of age. Fourteen patient (37.8%) had consanguinuous parents. Two patients had only myoclonic seizures, 8 patients had both myoclonic and absence seizures, 10 patients had myoclonic and generalized tonic clonic seizures and 17 patients had all 3 seizure types. Valproic acid monotheraphy was the most commonly used anti-epileptic drug. The mean duration between the first seizure and the diagnosis of JME was 2.5 years. Four patients were initially admitted to psychiatric unit. Carbamazepine was the initial drug of choice in 7 patients. None of the patients admitted to the hospital because of their absence or myoclonic jerks. Conclusion: A reason in the delay of diagnosis of JME in our study seems, as the inattentiveness of the patients, or the parents, concerning the myoclonias. Inadequate questioning due to either the inexperience of the physician or to linguistic difficulties for sufficient communication may be other possible causes.

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