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    4-h mean lactate clearance as a good predictor of adverse outcome in acute cardiogenic pulmonary edema: a pilot study
    (Walter De Gruyter Gmbh, 2024) Vural, Abdussamed; Karapehlivan, Mahmut; Dolanbay, Turgut; Cumaoglu, Mustafa Oguz; Hatip, Ahmet Yunus; Cetinkaya, Yakup; Unalan, Adnan
    Objectives This pilot study aimed to evaluate the efficacy of the 4-h mean lactate clearance (LACclr) level as a predictive factor for in-hospital outcomes, 30-day mortality, and treatment success in patients with acute cardiogenic pulmonary edema (ACPE), a significant clinical form of acute heart failure (AHF).Methods A total of 44 patients diagnosed with acute pulmonary edema were included in the study. The patients were divided into two groups based on lactate levels and negative outcomes, and lactate and LACclr levels and negative outcomes were analyzed using statistical tests such as Fisher's exact test, Student's t-test, Mann-Whitney U test, and Receiver operating characteristic (ROC) analysis.Results The results indicated a statistically significant difference in the total hospitalization length of stay according to whether the patients had a negative outcome (intubation and in-hospital mortality) (p=0.033). Additionally, the area under the curve (AUC) value for 4-h mean LACclr was 0.795 in all patients, which was statistically significant in predicting 30-day mortality (p=0.033). The optimal cut-off value for the 4-h mean LACclr in predicting 30-day mortality was found to be 5.57 %, with 80 % sensitivity and 66.7 % specificity. The threshold to rule out 30-day mortality for all patients was 18.85 with 100 % sensitivity and 30.2 % specificity (AUC, 0.795 95 % CI [0.546-1.000], p=0.033).Conclusions These findings suggest that the 4-h LACclr level, calculated within 4 h of emergency department (ED) presentation, can be used as a predictive indicator for needing intubation, in-hospital mortality, and 30-day mortality and to identify patients at higher risk for adverse outcomes.
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    Pediatric Head Injuries Occur During the Play Childhood Period of 3-6 Years: A Sample from the South of Türkiye
    (2024) Cumaoglu, Mustafa Oguz; Vural, Abdussamed; Doğan, Mustafa; Yuruk, Burak; Özçelik, Mustafa; Sekme, Sabri
    Aim: Pediatric head traumas (HT) are of significant concern due to their potential for high mortality rates, which are influenced by the clinical progression of traumatic brain injury (TBI). HT poses a substantial risk of morbidity and mortality across all pediatric age groups, underscoring the importance of effective clinical management and follow-up procedures. The current study aims to evaluate the epidemiology, causes, and clinical outcomes of head injuries during childhood play between the ages of 3 and 6. Material and Method: Focused on pediatric patients aged 3-6 years who were admitted to the emergency department (ED) for HT, and required consultation from a neurosurgeon. Data collected included patients’ demographics, trauma etiology, cranial examination findings, laboratory results upon admission, cranial computed tomography findings, classification of TBI, treatment administered, and clinical progression. Results: The median Glasgow Coma Scale (GCS) scores were found to be significantly lower in the group with intraparenchymal injury compared to the group without intraparenchymal injury (p=0.008). The group with intraparenchymal injury exhibited a higher than expected occurrence of moderate TBI (p=0.012). Females exhibited significantly lower mean rank scores for age compared to males (p=0.032). Patients hospitalized for HT had significantly lower GCS scores than those discharged (p=0.001). There is a higher prevalence of moderate TBI than expected in the group of hospitalized patients (p=0.008). The mortality rate among hospitalized patients was 5.6%, with lower GCS scores and hyperglycemia upon admission significantly associated with fatalities (p=0.015, p=0.045). Conclusion: Identification and management of moderate TBI are imperative in children presenting to the ED with HT during early childhood play. Children with intraparenchymal injury should be hospitalized. Additionally, hyperglycemia in pediatric HT patients may signify high-energy trauma.