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    Comparison of APACHE II and Modified Charlson Index in Mortality Prediction in Patients at Medical Intensive Care Unit
    (2022) Bulur, Oktay; Efe, Fatma Kaplan; Iynem, Hatice Kevser; Koç, Süleyman; Beyan, Esin
    Acute Physiology and Chronic Health Evaluation II (APACHE II) and Modified Charlson Index (MCI) are used to predict the fatality in intensive care units (ICU). We aimed to investigate the difference between these scores in the prediction of fatality in the medical intensive care unit. Our study is important because in our literature overview, this study is one of the rare studies that compares these scoring systems. 108 ICU patients included. In all subjects APACHE II and MCI performed. Procalcitonin, C-reactive protein(CRP) levels of patients were recorded. Patients were then grouped according to mechanically ventilated or not; mortality happened or not. Statistically significance found in age(p<0.045), mechanical ventilation, procalcitonin, CRP and MCI (p<0.001) about mortality . MCI sensitivity and specifity were higher than APACHE II in %95 confidance interval. Area under curve in ROC analysis was CRP (0.728), Procalcitonin (0.719), MCI (0.686), APACHE II (0.665) respectively. Our study demonstrates that the Modified Charlson Index combined with procalcitonin and CRP can be used for predicting mortality in medical ICU as well as APACHE II 
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    The Invisible Part of “ICEBERG”:Extraintestinal Findings and Celiac Disease
    (2022) Karakay, Serdar; Karadağ, İbrahim; Yildirim, Aslihan Mete; Bulur, Oktay; Uzman, Metin; Beyan, Esin
    Aim: Clinical manifestations of celiac disease (CD) can be quite different and varying. The number of CDs presenting with atypical symptoms is increasing day by day. Hence, we aimed to determine how many patients with CD were atypical celiac through examining their admission complaints, clinical characteristics, laboratory results, endoscopic findings, and pathological findings. Material and Methods: Eighty-nine patients with CD aged over 18 years who were followed-up in Ankara Kecioren Training and Research Hospital Internal Medicine Clinic between 2007 and 2014 were included in the study. The files of the patients were reviewed retrospectively. Sex, age, hospital admission complaints, clinical characteristics, laboratory results, endoscopy findings, and pathology results of the patients were recorded. Results: The median age of the patients in the study was 36, and 68.5% of them were female. The most common symptoms of the patients were fatigue (49.4%), anorexia (33.7%), and dyspepsia (22.5%), while diarrhea (19.1%), which is among the classical symptoms, was less common. 7.8% of the patients had no complaints at the time of admission, whereas 47.1% of them had only extraintestinal symptoms. At admission, 47% of the patients had anemia, 73.4% had iron deficiency, and 55.4% of them had vitamin B12 deficiency. When hemoglobin, ferritin, and vitamin B12 levels were compared before and after a gluten-free diet, a significant increase was determined. Transaminase elevation was detected in 25.3% of our patients at the time of diagnosis. When pre-treatment and post-treatment values were compared, a significant decrease was determined in those with high transaminase levels. In the pre-treatment serological test results of the patients, Ig A EMA positivity was the most common finding with a rate of 90.2%, followed by IgG EMA with 88.9%. In terms of pre-treatment endoscopy findings, 50.2% of our patients had normal appearance, 25.4% had a mosaic pattern, 12.6% had effacement of the duodenal folds, 12.6% had a nodular appearance, and 9.5% had a scalloping of the duodenal folds. When the pathology results of our patients were examined, 83.4% of them were at the advanced stage and with Marsh Type 3. Conclusion: CD may present with atypical complaints such as extraintestinal findings, as in more than half of the patients in this study. Celiac disease should be taken into consideration, particularly in conditions such as iron deficiency, osteoporosis, and transaminase elevations, which are prevalent in the community. The prevalence of CD in our country is estimated to be around 1-2%; however, it is considered that there are more asymptomatic patients with atypical celiac disease. When diagnosing CD, the most crucial step is to consider the potential presence of CD during pre-diagnoses. Thus, CD should be included in the differential diagnosis, specifically in patients presenting with atypical symptoms.