Person: BİLGİLİ, BELİZ
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BİLGİLİ
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BELİZ
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Publication Open Access Reduction of nosocomial infections in the intensive care unit using an electronic hand hygiene compliance monitoring system(2021-12-01) GÜL, FETHİ; YAKUT, NURHAYAT; BİLGİLİ, BELİZ; KASAPOĞLU, UMUT SABRİ; ARSLANTAŞ, MUSTAFA KEMAL; KEPENEKLİ KADAYİFCİ, EDA; Akkoc G., Soysal A., GÜL F., KEPENEKLİ KADAYİFCİ E., Arslantas M. K., Yakut N., BİLGİLİ B., Demir S. O., Haliloglu M., Kasapoglu U. S., et al.Introduction: Healthcare-associated infection is an important cause of mortality and morbidity worldwide. Well-regulated infection control and hand hygiene are the most effective methods for preventing healthcare-associated infections. This study evaluated and compared conventional hand hygiene observation and an electronic hand-hygiene recording and reminder system for preventing healthcare-associated infections. Methodology: This pre-and post-intervention study, employed an electronic hand-hygiene recording and reminder system for preventing healthcare-associated infections at a tertiary referral center. Healthcare-associated infection surveillance was recorded in an anesthesia and reanimation intensive care unit from April 2016 to August 2016. Hand-hygiene compliance was observed by conventional observation and an electronic recording and reminder system in two consecutive 2-month periods. healthcare-associated infections were calculated as incidence rate ratios. Results: The rate of healthcare-associated infections in the electronic hand-hygiene recording and reminder system period was significantly decreased compared with that in the conventional hand-hygiene observation period (incidence rate ratio = 0.58; 95% confident interval = 0.33-0.98). Additionally, the rate of central line-associated bloodstream infections and the rate of ventilator-associated pneumonia were lower during the electronic hand hygiene recording and reminder system period (incidence rate ratio= 0.41; 95% confident interval = 0.11-1.30 and incidence rate ratio = 0.67; 95% confident interval = 0.30-1.45, respectively). Conclusions: After implementing the electronic hand hygiene recording and reminder system, we observed a significant decrease in healthcare-associated infections and invasive device-associated infections. These results were encouraging and suggested that electronic hand hygiene reminder and recording systems may reduce some types of healthcare-associated infections in healthcare settings.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 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 Open Access MSC transplantation in eight severe covid-19 patients: can cytokine storm be reversed(2020-05-01) BİLGİLİ, BELİZ; Bilgili B.Background: In this clinical case report, we evaluated the clinical and the efficacy outcomes of Mesenchymal Stem Cells (MSCs) transplantation in eight severe COVID-19 patients with pneumonia Methods: MSCs were administered to eight severe/critically severe patients, unresponsive to treatment algorithms patients were also reviewed without MSC transplantation. Results: could not achieve clinical improvement and passed away. In all eight patients, compared to the baseline, there was a significant decrease in CRP (p=0.036), fibrinogen (p=0.012) and Hb (p=0.03) values on post treatment day 5. While there was an increase in lymphocyte count between baseline and post treatment, the change didn’t reach statistical significance (p=0.06). There was no statistically significant change in ferritin, neutrophil count, respiratory rate, oxygen saturation, troponin and platelet count (p>0.05) between baseline and post-treatment day 5. Conclusion: Four patients were discharged from the ICU after MSC transplantation. Although there was an immediate significant improvement in their prognostic markers, the other four patients remained in critically severe condition and passed away. In two severe patients, the recovery was faster after MSC transplantation than the other two critically severe recovered patients. This may indicate the potential benefit of MSC transplantation performed in an earlier clinical stage. Moreover, we can advise MSC transplantation when the poor prognostic markers (decrease in lymphocyte number, increase in fibrinogen and CRP) are observed in the severe COVID-19 patients, to overcome alveolar damage due to “cytokine storm.” This observation may introduce an algorithm for a supportive treatment with MSC transplantation for COVID-19 patients, which needs to be confirmed by broader randomized controlled trials.Publication Open Access Vitamin D level is associated with mortality predictors in ventilator-associated pneumonia caused by Acinetobacter baumannii(J INFECTION DEVELOPING COUNTRIES, 2016-06-30) BİLGİLİ, BELİZ; Haliloglu, Murat; Bilgili, Beliz; Haliloglu, Ozlem; Yavuz, Dilek Gogas; Cinel, IsmailIntroduction: Vitamin D plays a role in host defense and is known to be associated with mortality in patients in the intensive care unit (ICU). We aimed to evaluate the relationships between vitamin D levels and predictors of mortality in patients with ventilator-associated pneumonia (VAP) caused by extensively drug-resistant Acinetobacter baumanii (XDR A. baumanii). Methodology: A retrospective single-center study was conducted in an 18-bed adult ICU of a teaching hospital, including all patients with VAP due to XDR A. baumanii. Levels of 25(OH) D, procalcitonin (PCT), C-reactive protein (CRP), n-terminal pro-BNP (NT-proBNP), as well as clinical scores (Sequential Organ Failure Assessment [SOFA], Acute Physiology And Chronic Health Evaluation [APACHE II], Clinical Pulmonary Infection Score [CPIS) were recorded. Results: Forty-for patients were studied over six months. All patients had vitamin D deficiency. The 28-day mortality in patients with 25(OH) D levels <= 10 ng/mL was higher than in patients with 25(OH) D > 10ng/mL (p = 0.001). The fourth-and seventh-day SOFA scores (p=0.04 and p=0.001) and first-and fourth-day procalcitonin levels (p = 0.03 and p = 0.004) were higher in patients with 25(OH) D levels <= 10 ng/mL. The clinical scores (SOFA, CPIS, and CEPPIS) and biomarkers (NT-proBNP, PCT) were negatively correlated with 25(OH) D levels in all study groups. Conclusions: Severe vitamin D deficiency was associated with adverse outcome in VAP due to XDR A. baumanii. Vitamin D levels may be a prognostic predictor of VAP. It is also important to evaluate the effect of rapid vitamin D replacement on mortality.Publication Open Access A Comparison of Pregabalin and Ketamine in Acute Pain Management After Laparoscopic Cholecystectomy(AVES, 2018-02-22) BİLGİLİ, BELİZ; Haliloglu, Murat; Bilgili, Beliz; Zengin, Seniyye Ulgen; Ozdemir, Mehtap; Yildirim, Ahmet; Bakan, NurtenObjective: Pregabalin and ketamine are popular analgesic adjuvants for improving perioperative pain management. We designated this double-blind, placebo controlled study to test and compare the preventive effects of pregabalin and ketamine on postoperative pain management after elective laparoscopic cholecystectomy. Methods: Seventy five patients (18 to 65 years of age) undergoing laparoscopic cholecystectomy were randomly assigned to one of the following 3 groups: control group (group C) received oral placebo capsule 1 h before surgery and bolus plus intravenous (iv) infusion of saline during surgery; ketamine group (group K) received oral placebo capsule 1 h before surgery and 0.3 mg kg(-1) iv bolus plus 0.05 mg kg(-1) h(-1) iv infusion of ketamine during the surgery; pregabalin group (group P) received oral pregabalin 150 mg 1 h before surgery and bolus plus iv infusion of saline during surgery. The anesthetic technique was standardized, total tramadol consumption, visual analog scale (VAS), incidence of postoperative nausea and vomiting (PONV), sedation score and complications related to the drugs used in the study were assessed in the postoperative 24 h period. Results: Postoperative total tramadol consumption were significantly lower in the pregabalin and ketamine group compared to the group C (p=0.001). Tramadol requirement was similar between pregabalin and ketamine groups. At 30 min postoperatively, VAS values were lower in the pregabalin and ketamine groups compared with group C (p=0.001). There was no difference between the three groups in the need for supplemental analgesia, incidence of PONV and sedation score >2. Discussion: Pregabalin and ketamine improved postoperative pain control and decreased analgesic consumption after laparoscopic cholecystectomy with a good safety profile without any changes in sedation level or PONV.Publication Open Access The impact of the analgesic agents administered in recipients of liver transplants on graft results(2022-01-01) BİLGİLİ, BELİZ; A S., Çabakli G T., Y K., Bilgili B., C Y., T U.Introduction and Objective The ischemia-reperfusion injury that occurs in both the donor and the recipient during liver transplantation and the hemodynamic changes that may occur in graft afterward significantly affect the graft, sometimes triggering graft failure by causing hepatocyte damage. It is known that inhalation anesthetics provide ischemic preconditioning that prevents ischemia-reperfusion injury, but their effect on graft dysfunction caused by post-reperfusion syndrome has not yet been clarified. Our study aimed to reveal the effects of desflurane and sevoflurane used during liver transplantation on graft survival. Material and Method This retrospective study was conducted following the ethics committee approval (protocol no: 09.2021.1004/03.09.2021) and included 60 donors and recipients of liver transplantation procedures performed between 2015 and 2021. The patients were divided into two groups depending on the agent administered for anesthesia maintenance after Anesth Crit Care 2022; 4 (1): 43-51 DOI: 10.26502/acc.037 Anesthesia and Critical Care 44 standard anesthesia induction: desflurane group (Group 1, n=30) and sevoflurane group (Group 2, n=30). Recorded patient data included age, gender, body mass index, smoking status, comorbidities, presence of renal disease, total liver volume, graft volume, remaining liver volume, total ischemic time, and duration of anesthesia and surgery, graft survival, hospital stay, diastolic blood pressure measured at the beginning and the end of the procedure, systolic blood pressure; and the values of aspartate aminotransferase (AST), alanine aminotransferase (ALT), international normalized ratio (INR), albumin, total bilirubin, blood urea nitrogen, creatinine, platelet count, and hemoglobin at the postoperative 1, 7, and 30 days. Results Demographic data and length of hospital stay of the recipients were similar (p>0.05). Intraoperative urine output of the recipient patients in the desflurane group (Group 1: 1909.52 1269.90, Group 2: 918.75618.14), ALT level at postoperative 7th day, and total bilirubin value at the 6th month were found to be significantly higher compared to the sevoflurane group (p <0.01). Discussion and Conclusion Our study revealed that preconditioning with sevoflurane during liver transplantation may have greater positive effects on early hepatic and renal functions as compared to desflurane. However, we think that it is necessary tocarry out further prospective randomized studies.Publication Open Access Serum vitamin D level variation in SIRS, sepsis and septic shock(MARMARA UNIV, FAC MEDICINE, 2019-10-31) BİLGİLİ, BELİZ; Gul, Fethi; Arslantas, Mustafa K.; Bilgili, Beliz; Besir, Ahmet; Kasapoglu, Umut S.; Karakurt, Sait; Cinel, IsmailObjectives: Vitamin D has potent immunomodulatory effects with the capability of acting as an autocrine and paracrine agent, and inhibits inflammatory signaling. In this study, our aim was to evaluate the relationship between vitamin D levels in systemic inflammatory response syndrome (SIRS), sepsis and, septic shock patients and outcomes. Patients and Methods: A total of 45 patients whose vitamin D levels were measured within the first 48 hours of Intensive Care Unit (ICU) admission and 20 healthy controls were studied prospectively. The patients were grouped as, SIRS (Group-I,n=10), sepsis (Group-II, n=25), septic shock (Group-III, n -10) and healthy subjects (Group-IV, n=20). Serum vitamin D levels were categorized as a deficiency (<= 15ng/mL), insufficiency (16-29ng/mL) and sufficiency (>= 30ng/mL). Demographic characteristics, Acute Physiology and Chronic Health Assessment II (APACHE-II) scores, and biochemical parameters were noted. Results: Vitamin D levels were significantly lower in all study groups compared to the control group (p<0.01), but were similar among the study groups. The hospital and ICU length of stay (LOS), and biochemical parameters were similar among the study groups. The mortality rates were 40% in Group I, 57 % in Group II, and 80 % in Group III. Conclusion: In our study patients with SIRS, sepsis and septic shock had lower serum 25-OH vitamin D levels compared to the control group. Our results are in line with the literature that supports a relationship between vitamin D deficiency and inflammation.Publication Open Access Potential value of pleth variability index in intraoperative fluid management of geriatric surgical patients(2022-03-01) ORHON ERGÜN, MELİHA; UMUROĞLU, TÜMAY; BİLGİLİ, BELİZ; ZENGİN, SENİYYE ÜLGEN; ORHON ERGÜN M., ZENGİN S. Ü., BİLGİLİ B., UMUROĞLU T.Aim: This study was designed to determine the effects of pleth variability index (PVI) guided monitoring on the optimal intravascular volume replacement during hip and knee arthroplasty in geriatric patients, and whether using PVI could reduce blood transfusion and vasopressor requirements. Methods: One-hundred geriatric patients who underwent elective hip and knee arthroplasty were included, assigned to either PVI group (volume replacement was PVI guided) or to a control group (volume replacement was based on traditional methods). Sealed envelope technique was used for randomization. Perioperative hemodynamic parameters, infusion rate of crystalloids, colloids, blood/blood products, ephedrine hydrochloride requirements and perioperative urine outputs were recorded. Results: Crystalloid infusion rate was higher (9.5 vs. 6.8 ml/kg/h, p<0.001) and ephedrine requirement was lower (2.0% vs. 38.0%, p<0.001) in group PVI. Postoperatively, the percentage of patients with high BUN, creatinine, and lactate levels were higher among controls (p<0.001). PVI group had significantly lower mean heart rate intraoperatively. Conclusions: Our findings suggest that intraoperative fluid replacement guided by PVI monitoring provides hemodynamic stability, preserves normal levels of BUN, creatinine, and lactate, and reduces unnecessary use of vasopressor agents in elderly surgical patients.Publication Open Access Candida Infections in Intensive Care Unit Patients: How to Diagnose?(AVES, 2020-01-09) BİLGİLİ, BELİZ; Bilgili, BelizCandida infection is a serious problem associated with increased morbidity and mortality in intensive care unit (ICU). Multiple risk factors and severe diseases make patients vulnerable to fungal infections in ICUs. Diagnosis of Candida infections should be established rapidly in order to initiate the efficient treatment early. Diagnosis of Candida infections is a very challenging process for clinicians due to comorbidities and complex clinical conditions in the critically ill patients. Growth of the agent in blood, sterile body fluid and tissue cultures or histopathological diagnosis are the main methods for the diagnosis. The biomarkers for fungal agents and various risk factors of the patient are also used for diagnostic purposes with clinical evaluation.