Person: CİNEL, İSMAİL HAKKI
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CİNEL
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İSMAİL HAKKI
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Publication Metadata only Terapötik Hipotermi Sonrası Gelişen Enfeksiyonların Öngörülmesinde Hematoloji Parametrelerinin Kullanımı(2017-10-29) HAKLAR, GONCAGÜL; GÜL, FETHİ; KASAPOĞLU, UMUT SABRİ; CİNEL, İSMAİL HAKKI; GÜL F., ÇEVLİK T., ARSLANTAŞ M. K., KASAPOĞLU U. S., HAKLAR G., CİNEL İ. H.Publication Open Access An outbreak investigation of Burkholderia cepacia infections related with contaminated chlorhexidine mouthwash solution in a tertiary care center in Turkey(BMC, 2021-12) GÜL, FETHİ; Bilgin, Huseyin; Gelmez, Gulsen Altinkanat; Bayrakdar, Fatma; Sayin, Elvan; Gul, Fethi; Pazar, Nazli; Culha, Gulcan; Yildiz, Serap Suzuk; Cinel, Ismail; Korten, VolkanBackground: We report a nosocomial outbreak caused by Burkholderia cepacia that occurred among six patients admitted in the medical and surgical intensive care unit between 04 March 2019 and 02 April 2019 in Istanbul, Turkey. Methods: The outbreak investigation was launched on 11 March 2019 five days after the detection of B. cepacia in four different patients. We defined potential reservoirs and started environmental screening. We sampled the liquid solutions used in patient care activities. Pulse-field gel electrophoresis (PFGE) was performed to determine the genetic relatedness of environmental and patient samples. Results: Burkholderia cepacia was isolated in tracheal aspiration cultures of six patients. Three out of six patients developed healthcare-associated pneumoniae due to B. cepacia. Environmental cultures in the ICUs revealed B. cepacia growth in 2% chlorhexidine-gluconate mouthwash solution that been used in the colonized patients as well as in samples obtained from the unused products. PFGE revealed the patient and a specific batch of chlorhexidine mouthwash solution samples had a 96% similarity. Conclusion: Contamination of medical solutions used in critical patient care could cause outbreaks and should be detected early by infection control teams.Publication Metadata only The initial resuscitation of septic shock(W B SAUNDERS CO-ELSEVIER INC, 2020) GÜL, FETHİ; Cinel, Ismail; Kasapoglu, Umut S.; Gul, Fethi; Dellinger, R. PhillipSeptic shock is the most severe form of sepsis, characterized by (a) persistent hypotension despite fluid resuscitation and (b) the presence of tissue hypoperfusion. Delays in the diagnosis and initiation of treatment of septic shock is associated with increasing risk for mortality. Early and effective fluid resuscitation and vasopressor administration play a crucial role in maintaining tissue perfusion in septic shock patients. A low diastolic arterial pressure (DAP) correlates with severity of arteriolar vasodilation, compromises left ventricle oxygen supply and can be used for identifying septic shock patients thatwould potentially benefit fromearlier vasopressor therapy. Controversy currently exists as to the balance of fluids and vasopressors to maintain target mean arterial pressure. The aim of this article is to review the rationale for fluid resuscitation and vasopressor therapy and the importance of both mean and diastolic blood pressure during the initial resuscitation of the septic shock. We relate our personal prescription of balancing fluids and vasopressors in the resuscitation of septic shock. (c) 2020 Elsevier Inc. All rights reserved.Publication Open Access Renal Resistive Index is Unsusceptible to Systemic Hemodynamics in Fluid Responsive Critically III Patients(GALENOS YAYINCILIK, 2019-11-12) BİLGİLİ, BELİZ; Gul, Fethi; Bilgili, Beliz; Arslantas, Mustafa Kemal; Ayhan, Secil Ozcan; Cinel, IsmailObjective: The primary goal of fluid resuscitation in critically ill patients is to improve oxygen delivery to ensure adequate organ perfusion. Little evidence is known about renal response to fluids in the acute phase, so renal monitoring after the fluid challenge is fundamental during critical care stay. This study aimed to evaluate changes in the renal resistive index (RRI) and to compare these changes with hemodynamic parameters after fluid challenge in fluid responsive critically ill patients. Materials and Methods: Thirty patients older than 18 years who underwent sedation and received mechanical ventilation were prospectively studied. Twenty patients were fluid responsive and were included in the study. An increase of cardiac output (CO) by 10% or more after PLR measured by ultrasonic CO monitor suspected fluid responsiveness. 500 mL of isotonic solution was administered intravenously for 30 minutes. CO measurements were performed at 0, 1 and 30 minutes. RRI and mean arterial pressure (MAP) were measured by Doppler ultrasonography at 0 and 30 minutes. Repeated measures ANOVA method was used for statistical analysis and p<0.05 was considered significant. Results: CO increased significantly after fluid challenge when compared to baseline (from 3.48 +/- 1.14 to 4.34 +/- 1.43 L/min, p<0.001). MAP increased significantly after fluid administration when compared to baseline (80 +/- 19 to 86 +/- 17, p=0.002). RRI did not significantly differ from baseline after fluid challenge (62 +/- 9 to 60 +/- 10, p=0.11). There was a negative correlation between RRI and MAP at baseline and after fluid challenge. Conclusion: The effect of hemodynamic changes on renal perfusion after fluid challenge is controversial. In our study, 500 mL of crystalloid treatment for 30 minutes increased MAP and CO, but did not contribute to the improvement of RRI in patients who were fluid responsive. We found that fluid challenge did not improve RRI in the early phase of the fluid resuscitation in fluid responsive critically ill patients and RRI is unsusceptible to systemic hemodynamic changes during this period.Publication Metadata only Treatment approach of cerebral ischemia after revascularization surgery of moyamoya disease: Case report(2019-05-05) GÜL, FETHİ; KASAPOĞLU, UMUT SABRİ; CİNEL, İSMAİL HAKKI; GÜL F., KABADAYI F., KASAPOĞLU U. S., CİNEL İ. H.Publication Metadata only Peripartum cardiomyopathy mimicking acute aortic dissection: successful salvage with extracorporeal membrane oxygenation support(BAYCINAR MEDICAL PUBL-BAYCINAR TIBBI YAYINCILIK, 2014) KEPEZ, ALPER; Isbir, Selim; Ak, Koray; Aslantas, Mustafa; Kepez, Alper; Cinel, Ismail; Arsan, SinanIn this article, we report a case admitted with severe chest pain associated with ST segment elevation, pericardial effusion and aortic flap appearance in echocardiography at the 31 weeks of gestation, mimicking aortic dissection, but diagnosed with peripartum cardiomyopathy and successfully treated with extracorporeal membrane oxygenation after developing acute cardiogenic shock.Publication Open Access Sequential Measurements of Pentraxin 3 Serum Levels in Patients with Ventilator-Associated Pneumonia: A Nested Case-Control Study(HINDAWI LTD, 2018) BİLGİLİ, BELİZ; Bilgin, Huseyin; Haliloglu, Murat; Yaman, Ali; Ay, Pinar; Bilgili, Beliz; Arslantas, Mustafa Kemal; Ozdemir, Filiz Ture; Haklar, Goncagul; Cinel, Ismail; Mulazimoglu, LutfiyePurpose. The main purpose of this study was to investigate the dynamics of pentraxin 3 (PTX3) compared with procalcitonin (PCT) and C-reactive protein (CRP) in patients with suspicion of ventilator-associated pneumonia (VAP). Materials and Methods. We designed a nested case-control study. This study was performed in the Surgical Intensive Care Unit of a tertiary care academic university and teaching hospital. Ninety-one adults who were mechanically ventilated for >48 hours were enrolled in the study. VAP diagnosis was established among 28 patients following the 2005 ATS/IDSA guidelines. Results. The median PTX3 plasma level was 2.66 ng/mL in VAP adults compared to 0.25 ng/mL in non-VAP adults (p < 0.05). Procalcitonin and CRP levels did not significantly differ. Pentraxin 3, with a 2.56 ng/mL breakpoint, had 85% sensitivity, 86% specificity, 75% positive predictive value, and 92.9% negative predictive value for VAP diagnosis (AUC = 0.78). Conclusions. With the suspicion of VAP, a pentraxin 3 plasma breakpoint of 2.56 ng/mL could contribute to the decision of whether to start antibiotics.Publication Metadata only Comparing the accuracy of predictors of mortality in ventilator associated pneumonia(2016-04-20) BİLGİLİ, BELİZ; KASAPOĞLU, UMUT SABRİ; CİNEL, İSMAİL HAKKI; HALİLOĞLU M., BİLGİLİ B., KASAPOĞLU U. S., SAYAN İ., SÜZER ASLAN M., YALÇIN A., CİNEL İ. H.Publication Metadata only Lazer cerrahisi sırasında gelişen trakeobronşial inhalasyon yanığı- olgu sunumu(2017-10-29) KASAPOĞLU, UMUT SABRİ; GÜL, FETHİ; YUMUŞAKHUYLU, ALİ CEMAL; UMUROĞLU, TÜMAY; CİNEL, İSMAİL HAKKI; KASAPOĞLU U. S., GÜL F., ARSLANTAŞ M. K., YUMUŞAKHUYLU A. C., YAMANSAVCI E., UMUROĞLU T., CİNEL İ. H.Publication Metadata only Dirençli septik şokta desmopressin(2015-12-06) BİLGİLİ, BELİZ; KASAPOĞLU, UMUT SABRİ; CİNEL, İSMAİL HAKKI; HALİLOĞLU M., BİLGİLİ B., KASAPOĞLU U. S., SAYAN İ., ÇİFTÇİ M., CİNEL İ. H.