Gülşah Güneş Şahin

Introduction and aimTo determine the association between whole blood thiamine pyrophosphate (TPP) concentrations in critically ill patients and plasma metabolites and linked metabolic pathways using high resolution metabolomics.Patients and methodsThis cross-sectional study was performed at Erciyes University Hospital, Medical Intensive Care Unit (ICU), Kayseri, Turkiye and Emory University Department of Medicine Clinical Biomarkers Laboratory, Atlanta, GA, USA. Participants were enrolled as follows;≥18 years of age, with an expected length of ICU stay longer than 48 h and receiving furosemide therapy for at least 6 months or longer before ICU admission.ResultsBlood for TPP and metabolomics was obtained on the first day of ICU admission. Whole blood TPP concentrations were measured using high-performance liquid chromatography (HPLC). Liquid chromatography/mass spectrometry for high …

Introduction and aimOne of the most common causes of trauma is traffic accidents. Although the death rate is decreasing day by day as a result of trauma-related injuries, the incidence of injury is still very high (1). Morbidity is decreasing due to the development of pre-hospital emergency interventions and the increase of authorized personnel. Likewise, intensive care support is of great importance (2). The aim of the study is to sequentially determine serum adipokine levels in critically ill adult patients followed in the intensive care unit due to trauma.Patients and methodsThe study was carried out in Erciyes University Medical Faculty Hospital Internal Diseases Intensive Care Unit. Thirty patients aged 18 years and older and 30 healthy volunteers were included in the study. The patients consisted of patients who were admitted to the intensive care unit due to trauma, stayed for at least 7 days, and did not have any …

Introduction and aimThiamine plays a crucial role on energy metabolism. In critically ill patients, the provision of adequate nutritional support may lead thiamine deficiency. Thiamine deficiency may prevent to use of energy in metabolism in critical illness. This condition may create vicious circle, lead to severe thiamine depletion. Therefore, the determine of thiamine status is important. The analysis of plasma thiamine analysis to determine thiamine level is affected by inflammation related to critical illness. Erythrocyte thiamine pyrophosphate (eTPP) concentration, which is another method for assessing thiamine status, is not affected by inflammation. However, it is a relatively more difficult technical method. The aim of study was to determine the effect of inflammation on plasma thiamine level by accepting the eTPP level as the gold standard in critically ill patients.Patients and methodsThis study performed …

Introduction and aimNutrition plays a major role in the treatment of patients hospitalized in the intensive care unit (ICU). Micronutrients have important functions in carbohydrate, protein, and lipid metabolism, which are necessary for energy production (1). In critically ill patients, micronutrient deficiencies occur as a result of inadequate intake, inadequate absorption, increased requirement, or increased catabolism. There is a risk of micronutrient loss in critically ill patients receiving burns, trauma, or continuous renal replacement therapy (2). Early detection and prevention of micronutrient deficiencies is important for the life expectancy of patients (3). The aim of our study is to evaluate the changes in vitamin B1, B6, B9 and E levels on consecutive days in critically ill patients hospitalized in the intensive care unit.Patients and methodsThirty patients aged 18 years and older and hospitalized in the ICU for 48 h or more …

Methods: This study was prospectively conducted in the Medical Oncology Clinics. Serum phosphate levels< 2.5 mg/dl defined as hypophosphatemia [2, 4]. Patients aged 18 and over, expected to stay in the service for 48 hours or more, were included in the study. The patients were followed in the service for 14 days.Results: A total of 100 patients were included the study. The mean age of the patients was 59±9 years and 59% were male. The frequency of RH in any day was 87% in patients. The days when RH is seen with the highest rate are determined as the 3 rd and 12 th days (71% and 33%, respectively). Serum phosphorus levels of the patients by days are shown in table 1. When the patients are grouped as gastrointestinal system (GIS) cancer and non-GIS cancer; the frequency of RH was significantly higher in the GIS cancer group on the 3 rd and 11 th days than in the non-GIS cancer group. The amount of …

Background/ObjectivesThiamine plays a pivotal role in energy metabolism. The aim of the study was to determine serial whole blood TPP concentrations in critically ill patients receiving chronic diuretic treatment before ICU admission and to correlate TPP levels with clinically determined serum phosphorus concentrations.Subjects/MethodsThis observational study was performed in 15 medical ICUs. Serial whole blood TPP concentrations were measured by HPLC at baseline and at days 2, 5 and 10 after ICU admission.ResultsA total of 221 participants were included. Of these, 18% demonstrated low TPP concentrations upon admission to the ICU, while 26% of participants demonstrated low levels at some point during the 10-day study period. Hypophosphatemia was detected in 30% of participants at some point during the 10-day period of observation. TPP levels were significantly and positively correlated with …

PurposeIn an effort to better manage critically ill patients hospitalised in the intensive care unit (ICU) after experiencing multiple traumas, the present study aimed to assess whether plasma levels of intestinal epithelial cell barrier proteins, including occludin, claudin-1, junctional adhesion molecule (JAM-1), tricellulin and zonulin, could be used as novel biomarkers. Additional potential markers such as intestinal fatty acid-binding protein (I-FABP), d-lactate, lipopolysaccharide (LPS) and citrulline were also evaluated. We also aimed to determine the possible relationships between the clinical, laboratory, and nutritional status of patients and the measured marker levels.MethodsPlasma samples from 29 patients (first, second, fifth and tenth days in the ICU and on days 7, 30 and 60 after hospital discharge) and 23 controls were subjected to commercial enzyme-linked immunosorbent assay (ELISA) testing.ResultsOn first …

Background & Aims: Refeeding hypophosphataemia (RH) is associated with poor clinical outcomes and mortality rates. However, the presence of RH in patients with cirrhosis remains unknown. This study aimed to determine the relationship among the frequency of RH, nutritional status, and disease severity in patients with liver cirrhosis.Methods: This prospective study was conducted at a single-centre gastroenterology clinic. Malnutrition was identified using the Subjective Global Assessment (SGA). Disease severity was defined using the Child-Turcotte-Pugh (CTP) and the Model for End-Stage Liver Disease (MELD) scores. Hypophosphatemia was defined as a serum phosphate level of< 2.0 mg/dL.Results: Twelve of 50 cirrhotic patients (24%) had RH during hospitalization. The most common RH was determined in four patients on day four during the study follow-up. The sharpest decline in serum phosphate levels was observed on day four (median: 2.3 mg/dL). The CTP score and MELD scores did not differ significantly between RH and non-RH groups ((p= 0.478 and p= 0.643), respectively. The rate of malnutrition according to the SGA was 56.0%. A total of 82%, 4%, 8%, and 4% of participants received regular diet and oral nutritional supplements, only enteral tube feeding, only parenteral nutrition, and combined enteral and parenteral nutrition, respectively. In the RH group, 32% of participants received only parenteral nutrition and had a higher prevalence of RH than that of patients receiving only oral or enteral tube feeding (p= 0.001). The CTP score strongly and negatively correlated with serum phosphorus levels on days two (p= 0.016 …

Methods: Severity of disease was identified according to the Truelove and Witts score for ulcerative colitis (UC) and Crohn's Disease Activity Index (CDAI) for Crohn’s. Nutritional status was determined by the Subjective Global Assessment (SGA). Risk of RH was assessed using National Institute for Health and Care Excellence (NICE) criteria. Serum phosphate concentration was recorded for 7 days after hospitalization, and less than 0.65 mmol/l was defined as RH.Results: Fifty individuals (33 patients with UC and 17 patients with Crohn’s, mean age: 43.4±14.9 years) were recruited. RH had experienced 23 participants (46.0%). The most common presence of RH was observed on day 5 (n= 7 patients, 14.0%). The sharpest declines in serum phosphate level were determined on the 4 th day (0.74±0.18 mmol/l) and the 5 th day (0.74±0.28 mmol/l). Malnourished patients had higher RH ratio than other groups (p= 0 …

Methods: This study prospectively conducted in Gastroenterology Clinics and included patients who aged≥ 18 years, with liver cirrhosis and expected to hospital stay> 48 hours. Severity of disease was defined by Child-Turcotte-Pugh (CTP) and Model for End-Stage Liver Disease (MELD) score. Malnutrition was identified by Subjective Global Assessment (SGA). Serum phosphate levels was followed-up for 14 days after hospitalization. Serum phosphate levels< 2.0 mg/dl (0.65 mmol/L) defined as hypophosphatemia.Results: Our study included 50 participants aged with 64.0 (55.5-70.0) years. Of patients, the median CTP score was 6.0 (4.0-7.3) and the median MELD score was 10.5 (9.0-14.0). A total of 24% of our sample had RH during first 14 days period after admission. The most common RH was determined in 4 subjects (8%) in day 4. The serum phosphate concentrations of RH group and non-RH group were …

Background Ghrelin is a hormone that regulates appetite and energy metabolism. The change of serial serum total and acylated ghrelin levels during hospital stays of critical patients are unknown. In addition, the relationship of this change with the clinical results of patients in the intensive care unit (ICU) is also unknown. The aim of this study was to determine serum total and acylated ghrelin levels serially in critically ill patients. Methods This prospective study was performed in the ICU. Patients who were >18 years old and stayed in ICU for >48 h were included in the study. Serum total and acylated ghrelin concentrations were measured at baseline in all participants and serially on the 2nd, 5th, and 10th day after entry into the study in those who remained in the ICU. Results A total of 60 participants were included. The mean age was 56 ± 21 years. (Baseline, 2nd, 5th, and 10th day median serum total ghrelin …

Background & aims:: Infertility had an increasing trend among couples in Iran. Several factors such as lifestyle, physical activity, unhealthy dietary habits and stress are associated with production of ROS in seminal fluid. The aim of this study was to identify the role of dietary antioxidants and vitamins intake on semen quality parameters, among Iranian infertile men. Methods: This cross-sectional study was performed on 400 newly diagnosed infertile men in Yazd Reproductive Sciences Institute from July 2019 to December 2019. The presence of infertility was confirmed by an expert andrologist, based on WHO criteria. Dietary antioxidants and vitamins intake were assessed using a 168 items semi-quantitative food frequency questionnaire (FFQ). Results: We found an association between total motility and b-Cryptoxanthin dietary intake in the full adjusted model (P ¼ 0.03). Although a significant relationship was observed between b-Cryptoxanthin and normal morphology in the crude model, the association became non-significant after controlling for confounders. No further significant association was detected between antioxidant and nutrients, and fertility-related parameters.Conclusions: Present study suggests that dietary intake of b-Cryptoxanthin might be associated with an improvement in sperm motility. However, more research is needed to confirm these relations and provide the evidence needed to exert these findings into clinical practice.© 2022 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved.

Background & aimsEnteral Nutrition (EN) may be interrupted due to various reasons in the setting of intensive care unit (ICU) care. This study aimed to investigate the reasons, frequency, and duration of EN interruptions in critically ill patients within the first 7 days of ICU stay.MethodsA total of 122 critically ill patients (median age: 63 years, 57% were males) initiating EN within the first 72 h of ICU admission and continued EN for at least 48 h during ICU stay were included in this observational prospective study conducted at a Medical ICU. Patients were followed for hourly energy intake as well as the frequency, reason, and duration of EN interruptions, for the first seven nutrition days of ICU stay or until death/discharge from ICU.ResultsThe median APACHE II score was 22 (IQR, 17–27). The per patient EN interruption frequency was 2.74 and the median total EN interruption duration was 960 (IQR, 105–1950) minutes …

Methods: The study was conducted prospectively and randomly with 50 patients treated with HSCT. The data of the patients were recorded during their follow-up. Univariate logistic regression analysis was applied to examine the effect of all data on RH. Then, backward multivariate logistic regression analysis was performed with the data found to be significant (p< 0.2).Results: RH developed in 78% of patients treated with HSCT. Pre-transplantation PGSGA score, frequency of vomiting, and development of infection were higher in patients with RH (p< 0.05). The patients had a mean weight loss of 2.9% after transplantation. Pre-transplantation 88% of patients were well-nourished (PGSGA 0-3), post-transplantation 70% of patients were moderately undernourished (PGSGA 4-8) and 30% were severely malnourished (PGSGA≥ 9). While total protein and albumin decreased after transplantation, CRP increased (p< 0 …

Background Acute kidney injury (AKI) treated with continuous renal replacement therapy (CRRT) may deplete micronutrient levels. Patients are also at risk for micronutrient depletion due to underlying illness(s), poor nutrient intake prior to intensive care unit (ICU) admission and/or increased requirements. We determined vitamin and trace element status before, during and after CRRT in critically ill patients. Methods This prospective observational study performed in mixed medical and surgical ICU patients. Serial serum vitamin B6 and vitamin C concentrations were measured by HPLC and folic acid by ECLIA. Serum chromium, copper, selenium, and zinc were measured using ICP‐MS. Serum ceruloplasmin was measured by the Erel method. Results Fifty adult ICU patients with AKI were recruited. The median APACHE II score on ICU admission was high at 24.0 (6.0‐33.0). The median days on CRRT was 2.0 (2 …

Background The Global Leadership Initiative on Malnutrition (GLIM) published malnutrition identification criteria. The Mini Nutritional Assessment (MNA) is malnutrition assessment tool commonly used in older adults. This study aimed to determine prevalence of malnutrition and the relationship between the GLIM and the MNA long form (MNA‐LF) and short form (MNA‐SF) and energy‐protein intake. Methods A total of 252 older adult outpatients (aged 68.0 years, 61% females) were included. Malnutrition was defined according to the GLIM, MNA‐LF, and MNA‐SF. Food intake was assessed using the 24‐h dietary recall. We analyzed the cutoff value on the MNA‐LF score, MNA‐SF score, and energy‐protein intake for GLIM criteria–defined malnutrition severity with receiver operating characteristic analysis. Results Malnutrition was present in 32.2%, 12.7%, and 13.1% of patients according to the GLIM criteria …

Background & aimsTrace elements act as co-factors and/or in co-enzymes in many metabolic pathways and its deficiency contributes to metabolic and infectious complications. The aim of this study was to determine serum zinc, selenium, cobalt, chromium, copper and ceruloplasmin levels for identify the need for post intensive care unit (ICU) nutritional follow-up.MethodsThis study was prospectively conducted in medical ICU. Adult patients (≥18 years) who stayed in ICU more than 48 h and transferred to ward were included in the study. Blood samples of trace element levels were sampled at discharge.ResultsWe enrolled 100 patients. The median age was 60 (40–70) years with Acute Physiology and Chronic Health Evaluation II (APACHE II) score 15 (11-21) . The median C-Reactive Protein (CRP) level was 53.9 (24.8–116.0) mg/L at discharge. Median serum zinc (24.4 mcg/dl:14.2–38.7) and chromium (0.22 mcg …

Objective Refeeding hypophosphatemia (RH) is common in critically ill patients and is associated with high morbidity and mortality, but the influence on appetite-regulating hormones is unknown. This study aimed to determine the association between serum levels of phosphorus and specific appetite-regulating hormones in critically ill patients. Materials and Methods This study was performed prospectively in patients admitted to the intensive care unit (ICU). The study included patients aged≥ 18 years who were admitted to the ICU and feeding at least 72 hours (h). Serum was obtained at baseline, 24 h, and 72 h later for concentrations of leptin, adiponectin, ghrelin, resistin, insulin-like growth factor 1 (IGF-1), and glucagon-like peptide 1 (GLP-1). Phosphorus levels were accepted at≤ 2.4 mg/dL for RH. Results Of the 26 cases, 17 (65%) were male. The baseline phosphorus levels at baseline, 24 h, and 72 h were 3.58±0.94 mg/dL, 2.61±1.05 mg/dL, and 2.91±0.76 mg/dL, respectively. RH rate was developed 24 h, 72 h, and over time in 38%, 15%, and 42% patients, respectively. Adiponectin levels at 24 h were significantly different between patients who developed RH and those who did not develop RH. A positive correlation was observed between 24 h serum adiponectin level and 24 h phosphorus level. A positive correlation was found between baseline serum ghrelin level and baseline phosphorus level. No significant difference was found between RH and insulin, leptin, ghrelin, resistin, IGF-1, and GLP-1 at baseline, 24 h, and 72 h. Conclusion RH was found to be of high ratio in critically ill patients. Adiponectin level was found to be high at 24 …

Background/aim Adipokines play an important role in the regulation of metabolism. In critical illness, they alter serum levels and are suspected to worsen clinical outcomes. But the effect of the route of nutrition on adipokines is not known. The purpose of this study was to evaluate the association between the route of nutrition and adipokine levels in critically ill patients. Materials and methods This prospective study was performed in an intensive care unit (ICU). Patients admitted to the ICU for least 72 h and receiving either enteral nutrition (EN) via tube feeding or parenteral nutrition (PN) were enrolled. Serum was obtained at baseline, 24 h, and 72 h for concentrations of leptin, adiponectin, resistin, glucagon-like peptide 1 (GLP-1), insulin-like growth factors 1 (IGF-1), and ghrelin. Results A total of 26 patients were included in the study. Thirteen patients received EN and 13 patients received PN. In the PN group, leptin level significantly increased (P= 0.037), adiponectin and ghrelin significantly decreased during follow up (P= 0.037, P= 0.008, respectively). There was no significant change between all adipokines in the EN group and resistin, IGF-1 and GLP-1 in the PN group during follow up. Resistin levels were markedly lower in the EN group at both 24 h (P= 0.015) and 72 h (P= 0.006) while GLP-1 levels were higher in the EN group at baseline, 24 h, and 72 h (P= 0.018, P= 0.005, and P= 0.003, respectively). There were no differences in leptin, adiponectin, IGF-1, and ghrelin levels over time. Conclusion The delivery of EN in critical illness was associated with decreased resistin levels and increased GLP-1 levels. Thus, the route of nutrition may …

Purpose In Islam, Ramadan fasting is a unique model that is associated with the restriction of food and fluid intake. We aimed to estimate the physiological effects of Ramadan fasting on muscle function and muscle mass in the older people. Methods A random sample was recruited from healthy older Muslims people aged 60 years and older, who expressed an intention to fast for 30 days during the month of Ramadan. Walking speed was expressed in meters per second (m/s). Muscle strength was assessed by hand grip strength (HGS) with a dynamometer. A Bioelectrical impedance analysis (BIA) device (BodystatQuadScan 1500, UK) was used for the evaluation of body composition. Dietary data of the patients during Ramadan were obtained by a 43-item Food Frequency Questionnaire (FFQ). Results The mean age [Standard Deviation(SD)] of the older people was 66.7(4.7) years of age and 50% were …