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    A novel model for early prediction of in-hospital mortality in seawater drowning: the SNOP score
    (Bmc, 2025) Oncu, Kivanc; Ozcan, Ozhan; Kara, Seyma Simsirgil; Parmaksiz, Ayhan; Ersen, Teoman
    Background : Drowning is a leading cause of preventable mortality worldwide; however, early in-hospital risk stratification remains limited. Although tools such as the Szpilman score assist in early severity assessment, they may not fully capture the evolving clinical status after admission. This study aimed to develop a simplified and objective model based on readily available parameters to predict in-hospital mortality following seawater drowning. Methods : This retrospective study was conducted at a referral emergency department (ED) in northern Turkey between July 1, 2011, and December 31, 2024. Of 190 patients initially included, 166 with complete clinical and laboratory data were analyzed. Data were obtained from institutional and national health information systems. Clinical, physiological, and biochemical variables were assessed. Predictors of in-hospital mortality were identified using receiver operating characteristic (ROC) analysis and multivariable logistic regression. Variables with near-perfect discrimination (e.g., GCS, pH, Szpilman score) were excluded to avoid overfitting. Results : Among the 166 patients, 34 (20.5%) died during hospitalization. CPR and endotracheal intubation rates were significantly higher among non-survivors (CPR: 97.1% vs. 0%; intubation: 97.1% vs. 2.3%; both p < 0.001). Non-survivors also presented with lower GCS (median 3 vs. 15), lower arterial pH, and higher Szpilman scores (all p < 0.001). ROC analysis identified four potential predictors with AUC values between 0.90 and 0.95-pCO(2), lactate, SpO(2), and sodium-all showing significant discriminatory capacity (p < 0.001). These variables were entered into a binary logistic regression model, from which serum sodium (OR = 2.110; 95% CI: 1.310-3.401; p = 0.002) and SpO(2) (OR = 0.902; 95% CI: 0.847-0.961; p = 0.001) emerged as independent predictors. These formed the basis of the SNOP score (Saturation and Natremia-based Outcome Predictor), a two-parameter logistic model demonstrating excellent performance: AUC = 0.996, sensitivity = 99.0%, specificity = 96.2%, and overall accuracy = 98.4%. Conclusion: The SNOP score is a simple, ED-specific tool for early prediction of in-hospital mortality in seawater drowning. It complements existing assessment systems by incorporating objective, admission-based parameters. Prospective multicenter validation is warranted to confirm its clinical applicability and support broader implementation.
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    Effects of Haemodynamic Changes Caused by Different Pneumoperitoneum Pressures on Cerebral Oxygenation in Laparoscopic Cholecystectomy: Prospective Randomised Controlled Trial
    (Coll Physicians & Surgeons Pakistan, 2024) Oncu, Kivanc; Saylan, Sedat
    Objective: To evaluate the role of different pneumoperitoneum pressure ranges on cerebral oxygenation.Study design: Prospective, randomised controlled trial. Place and Duration of the Study: Karadeniz Technical University, Turkiye, from January to September 2020.Methodology: Seventy patients (aged 18-65 years, ASA I-IIII) scheduled for laparoscopic cholecystectomy were divided into two groups; low pressure (LP, 10-12 mmHg) and high pressure (HP, 13-15 mmHg). The heart rate, peripheral oxygen saturation, systolic, diastolic, and mean arterial pressure, BIS, end-tidal carbon dioxide, and left and right regional cerebral oxygen saturation (rSO2) were recorded during induction, at the beginning, and after 5, 10, 15, 30, 60, and 90th minutes of pneumoperitoneum, after the surgical and anaesthesia procedures.Results: The findings did not demonstrate a significant difference between the haemodynamic parameters of the groups. However, there were differences (fifth [p=0.022], fifteenth minutes [p=0.035], at the end [p=0038] of pneumoperitoneum in right rSO2, and similarly at the end [p=0.038] of pneumoperitoneum in left rSO2 between mean variation of rSO2 when compared to the baseline; cerebral oxygenation was better preserved in LP. While no patient had more than 20% rSO2 reduction in LP, a total of three patients had cerebral desaturation in HP.Conclusion: Although <15 mmHg pressure for pneumoperitoneum was usually well-tolerated by patients, it had been observed that cerebral oxygenation may be affected with this range. The pathophysiological effects of pneumoperitoneum and possible consequences of this situation should be considered while performing laparoscopy.
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    Epidemiological and clinical characteristics of seawater drowning cases in Sinop, a Turkish coastal city: a 13-year retrospective study
    (Bmc, 2025) Ersen, Teoman; Oncu, Kivanc; Ozcan, Ozhan; Kara, Seyma Simsirgil; Saglam, Mustafa; Orhun, Elif; Saglam, Dilsan Ozcanoglu
    Background Drowning is a significant public health issue, particularly in coastal regions such as Sinop, Turkey, where seasonal variations contribute to a high incidence of cases. However, there is a lack of long-term, population-based studies from the Black Sea region, where distinct environmental factors may influence drowning patterns. This study provides a comprehensive 13-year analysis of seawater drowning cases, including detailed demographic, clinical, and outcome characteristics, to inform prevention strategies and improve emergency response. Methods A retrospective, observational study was conducted on all patients admitted to the regional referral Emergency Department (ED) due to seawater drowning between July 2011 and July 2024. Demographic characteristics, clinical parameters, and outcomes were retrieved from institutional and national health record systems. Descriptive statistical analyses were performed. Results A total of 198 patients were included, of whom 69.2% were male, with a mean age of 29.6 years. The majority of cases (over 82%) occurred in July and August, and 51% involved tourists. Cardiopulmonary resuscitation (CPR) was performed in 17.7% of patients. Trauma was documented in 7.1% of patients; among these, the most commonly affected regions were the extremities (50.0%) and the head (35.7%). Laboratory analysis showed elevated lactate levels and reduced pH. On admission, most patients had preserved neurological status, while 19.2% presented with severe impairment (GCS <= 8). According to the Szpilman score, 37.9% had mild and 17.7% severe symptoms. The overall mortality was 19.7%, and 22.2% of patients required admission to the intensive care unit (ICU). Notably, 35.9% of all fatal cases (n = 14) involved individuals who drowned while attempting to rescue others. Conclusions Drowning imposes a substantial burden in coastal regions, disproportionately affecting young males during the summer. Our findings highlight the need for enhanced emergency preparedness and structured clinical response, as well as public education on water safety and safe rescue practices. These findings contribute valuable insight for developing regional and international strategies to mitigate drowning outcomes.
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    Moyamoya Disease Diagnosed With Intracranial Hemorrhage After Cesarean Section Under Spinal Anesthesia: A Case Report
    (Springernature, 2024) Ilyas, Yasir; Oncu, Kivanc; Ilyas, Kubra; Besir, Ahmet
    Moyamoya disease (MMD) is a rare non -inflammatory cerebral vasculopathy characterized by progressive stenosis of the internal carotid arteries, often bilaterally, and the formation of abnormal collateral vascular structures at the cranial base. A patient who underwent elective cesarean section (C/S) twice under spinal anesthesia and was diagnosed with MMD as a result of recurrent intracranial hemorrhage in the postpartum periods is presented. A 41 -year -old female patient without any systemic comorbidity, gravida 2, parity 2, had her second cesarean section (C/S) operation under spinal anesthesia and was discharged on the third postoperative day without any problems. The patient had a mild headache that started from the occipital region and spread to the entire cranium on the same day. After applying to the emergency department at different times, she was discharged with conservative treatment. The patient had a severe headache and was admitted to the emergency room on the ninth postoperative day. The patient, who was diagnosed with intracranial hemorrhage after cranial imaging, was referred. Cranial angiography revealed advanced bilateral internal carotid artery symmetric occlusion and the basilar artery was preserved. According to the angiographic image, the patient was diagnosed with moyamoya disease and was followed up in the intensive care unit. The muscle strength of the patient, who had no cranial nerve pathology or lateralization findings, was evaluated as normal. Conservative management was applied in the intensive care unit. The patient was discharged with recommendations for neurosurgery and cardiovascular surgery after 12 days. In the postpartum period, especially in cases of headache that persists for a long time after dural puncture and does not have a postdural feature, intracranial hemorrhage should be considered until proven otherwise, and moyamoya disease also be considered in the differential diagnosis of intracranial hemorrhage. The approach to the patient in the perioperative period should focus on providing normotension, normocapnia, normothermia, and effective analgesia.