Acta Medica Ruha

Vancomycin-Induced Immune Thrombocytopenia in an Older Patient in the Intensive Care Unit: A Case Report

Mahmut Sami İnce — Mon, 22 Dec 2025 00:00:00 +0300

To the Editor,

Thrombocytopenia is a frequent finding in patients treated in intensive care units, and determining its exact cause is essential for proper management. Among many possible etiologies, drug-related immune thrombocytopenia (DITP) is uncommon but clinically relevant. The disorder occurs when drug-dependent antibodies react with platelet surface glycoproteins, mainly GPIb/IX/V or GPIIb/IIIa, leading to immune-mediated destruction of platelets. Early recognition and discontinuation of the suspected medication are crucial to avoid potentially severe bleeding events (1-4).

Vancomycin is a glycopeptide antibiotic that inhibits bacterial cell wall synthesis and is used to treat gram-positive infections, particularly methicillin-resistant Staphylococcus aureus (5). In rare cases, vancomycin may trigger immune-mediated thrombocytopenia through a quinine-like mechanism. The drug can promote the formation of drug-dependent antibodies that bind to platelet glycoproteins such as GPIIb/IIIa, leading to immune destruction and platelet clearance (2, 6). In this letter, we describe a patient with septic shock who developed vancomycin-associated immune thrombocytopenia during intensive care treatment.

A 65-year-old woman with a history of ischemic cerebrovascular disease was admitted to the intensive care unit (ICU) due to fever and deterioration in her general condition. She was immobilized and had chronic comorbidities including diabetes mellitus, hypertension, and recent ischemic stroke. On admission, she fulfilled the criteria for septic shock secondary to a urinary tract infection, with an increase of more than two points in the Sequential Organ Failure Assessment (SOFA) score, hypotension requiring vasopressor support, and lactate levels exceeding 2 mmol/L. She was started on intravenous hydration, empiric broad-spectrum antibiotics (meropenem and vancomycin), vasopressors, and corticosteroids.

Initial laboratory tests revealed leukocytosis, elevated inflammatory markers (CRP and procalcitonin), increased urea and creatinine levels consistent with acute kidney injury, and a platelet count of 129×10³/µL. Coagulation tests (INR and aPTT) and liver enzymes were within normal limits, while lactate was elevated. The peripheral smear confirmed the platelet count (approximately 120×10³/µL) and ruled out platelet clumping. During follow-up, infection markers regressed, renal function normalized, and vasopressor requirements decreased. However, the platelet count continued to decline despite overall clinical improvement.

Over the next several days, the patient’s platelet values fell progressively, reaching below 20×10³/µL. A pooled platelet transfusion was administered, but the post-transfusion count did not show a meaningful increase. The patient’s clinical course and laboratory data suggested isolated thrombocytopenia without signs of disseminated intravascular coagulation (DIC), as fibrinogen, D-dimer, and coagulation parameters remained within normal limits. Serum lactate dehydrogenase (LDH) was 214 U/L (135–214 U/L), total and indirect bilirubin levels were 0.4 and 0.1 mg/dL respectively (reference: 0.1–1.2 mg/dL and 0–0.5 mg/dL), and no schistocytes were observed in the peripheral smear, excluding hemolysis. The absence of renal deterioration or microangiopathic findings ruled out thrombotic microangiopathies such as hemolytic uremic syndrome (HUS), atypical HUS, and thrombotic thrombocytopenic purpura.

Since meropenem was considered more likely to cause thrombocytopenia, it was discontinued after Staphylococcus hominis was isolated, while vancomycin therapy was continued. Despite infection resolution, the platelet count failed to recover, excluding sepsis-related thrombocytopenia. The temporal relationship between vancomycin exposure and platelet decline, along with the absence of other etiologies, strongly suggested vancomycin-induced immune thrombocytopenia. The patient had not received heparin or low-molecular-weight heparin, excluding heparin-induced thrombocytopenia.

Given the possibility of immune-mediated thrombocytopenia, corticosteroid therapy was intensified to prednisolone 1 mg/kg/day. Despite three days of treatment, there was no platelet recovery, and intravenous immunoglobulin (IVIG) was initiated at 1 g/kg/day for two consecutive days. Vancomycin therapy was discontinued concurrently. Following drug withdrawal and IVIG administration, the platelet count increased markedly, reaching normal levels within two weeks. As the platelet count normalized and infection markers stabilized, corticosteroid therapy was gradually tapered and discontinued. The patient was discharged from the ICU.

Vancomycin-associated thrombocytopenia is an uncommon but clinically important adverse reaction that has been reported only in a limited number of cases (7). Literature data emphasize the importance of recognizing the condition early, promptly discontinuing the causative drug, and initiating appropriate therapeutic interventions, including corticosteroids, IVIG, and platelet transfusions when active bleeding is suspected (1). In our case, corticosteroid treatment had already been started for septic shock, but platelet recovery occurred only after IVIG administration. This observation suggests that, in critically ill patients receiving corticosteroids for septic shock, IVIG can be prioritized as a first-line option for drug-induced immune thrombocytopenia, avoiding unnecessary escalation of steroid therapy and potential adverse effects.

Sincerely.

Nutrition and Longevity in Aging: Dietary Strategies for Healthy Lifespan Extension

Nurgül Arslan, Hacer Alataş — Mon, 22 Dec 2025 00:00:00 +0300

Aging involves progressive physiological decline, increasing susceptibility to chronic disease and functional loss. Nutrition is a key modifiable determinant of healthspan, influencing oxidative stress, mitochondrial function, proteostasis, and nutrient-sensing pathways such as Mechanistic Target of Rapamycin (mTOR), Adenosine Monophosphate-Activated Protein Kinase (AMPK), Insulin-Like Growth Factor-1 (IGF-1), and sirtuins. Adequate protein preserves muscle mass, while high-quality fats especially omega-3s support cardiovascular, metabolic, and cognitive health. Low-glycemic, fiber-rich carbohydrates enhance insulin sensitivity and promote a diverse gut microbiome that generates short-chain fatty acids with anti-inflammatory effects. Dietary patterns like the Mediterranean diet, Blue Zone diets, and the Longevity Diet are linked to lower cardiometabolic risk and slower biological aging. Caloric restriction, intermittent fasting, and fasting-mimicking diets activate autophagy and mitochondrial efficiency. Effective implementation requires considering multimorbidity, polypharmacy, psychosocial factors, and food access. Advances in nutrigenomics, microbiome science, and digital health enable personalized nutrition, while sustainable plant-forward diets support both healthspan and environmental goals. Integrating nutrition into clinical care and public health can extend healthy lifespan and improve quality of life in older adults.

Effects of Non-pharmacological and Complementary Interventions on Foot Function in Painful and Non-painful Diabetic Peripheral Neuropathy

Fatmaz Zehra Küçük — Mon, 22 Dec 2025 00:00:00 +0300

Diabetic peripheral neuropathy (DPN) is a major determinant of diabetic foot disease and lower-limb amputation, affecting not only pain but also foot function, gait, balance, and ulcer risk. While non-pharmacological and complementary interventions are increasingly used as adjuncts to pharmacotherapy in both painful and non-painful DPN, the extent to which these approaches influence foot-related outcomes remains unclear. This review synthesises current evidence on the effects of non-pharmacological (e.g. foot–ankle exercise, physical therapy, insoles and orthoses, educational and web-based programmes) and complementary interventions (e.g. reflexology, acupuncture, Reiki, foot massage) on foot function in individuals with DPN. Across randomized and controlled trials, foot–ankle–focused exercise programmes consistently improved intrinsic foot muscle strength, plantar pressure distribution, ankle–foot kinematics, balance, and gait performance, and reduced mechanical risk factors associated with ulceration. Insoles and orthoses with various materials and designs were shown to lower peak plantar pressures and pressure–time integrals and redistribute load away from high-risk metatarsal head regions, supporting their role as effective off-loading strategies. Complementary therapies demonstrated beneficial effects on neuropathic pain and overall quality of life; however, foot function-specific outcomes (e.g. plantar pressure, deformity progression, ulcer incidence, foot-related quality of life) were rarely assessed and were typically reported only as secondary, limited endpoints. Overall, the evidence supports integrating structured exercise and podiatric off-loading strategies into DPN management, while highlighting the need for methodologically robust trials that systematically evaluate foot-centred outcomes to clarify the true podiatric impact of complementary interventions.

Obesity and Cardiometabolic Diseases: A Gut Microbiota Centered Perspective

İbrahim Bektaş, Nevin İlhan, Şükrü Akmeşe — Mon, 22 Dec 2025 00:00:00 +0300

The escalating trajectory of obesity worldwide constitutes a severe public health crisis, intimately linked to elevated rates of death and chronic disease burden. Contemporary medical understanding has shifted from viewing obesity solely as a caloric equilibrium issue to recognizing it as a complex, multifactorial pathology driven by neurohormonal disruptions, metabolic dysregulation, and inflammatory cascades. Adipose tissue is no longer regarded merely as an energy depot; it is an active endocrine organ where cellular expansion and hypoxia precipitate chronic low-grade inflammation, a precursor to insulin insensitivity and metabolic breakdown. Recently, the intestinal ecosystem has been identified as a central architect in the development of metabolic syndrome and cardiovascular impairments. Individuals with obesity typically exhibit a distinct microbial signature characterized by diminished diversity and dysbiosis. Mechanistically, the gut flora dictates host metabolic health by modulating lipid profiles, energy harvesting, and immune responses via several pathways, including the fermentation of fibers into short-chain fatty acids, the regulation of bile acid signaling, the modulation of metabolic endotoxemia, and the inhibition of FIAF. Of particular concern is the synthesis of trimethylamine-N-oxide (TMAO) by gut bacteria, which directly exacerbates atherosclerotic plaque progression and heightens platelet reactivity. Furthermore, the bidirectional communication via the gut-brain axis plays a pivotal role in regulating satiety and dietary choices. In light of these associations, therapeutic strategies that reshape the microbial landscape—ranging from probiotic and prebiotic administration to fecal microbiota transplantation and novel pharmacological modulators—hold significant promise for mitigating the cardiometabolic risks associated with obesity.

Historical Development And Economic Impact Of Physiotherapy

Şükran İpek Öksüz — Mon, 22 Dec 2025 00:00:00 +0300

Introduction: Physiotherapy is a healthcare discipline focused on promoting functional mobility, preventing disability, and enhancing quality of life through evidence-based interventions.

Objective: This study aimed to evaluate the historical institutionalization of physiotherapy and its economic reflections in global health systems.

Methods: A literature-based review was conducted using international policy documents, historical reports, and economic evaluation studies addressing physiotherapy’s development and integration into healthcare systems.

Results: Findings indicated that physiotherapy evolved from wartime rehabilitation efforts into a professionalized and cost-effective healthcare service. Recent digital transformations have further expanded its clinical, preventive, and economic scope.

Conclusion: Physiotherapy has become a strategic component of global health systems, contributing both to patient-centered care and to sustainable health economics. Its integration into wellness models and digital health platforms underscores its growing multidisciplinary importance.

Experiences of Nurses Providing Care to Burned Children Regarding Atraumatic Care Practices: A Qualitative Study

Özge Karakaya Suzan, Meryem Çalışkan, Nursan Çınar — Mon, 22 Dec 2025 00:00:00 +0300

Introduction: In pediatric burn care, atraumatic approaches are crucial to reducing children’s stress, pain, and anxiety, yet nurses’ experiences in this area remain insufficiently explored.

Objective: The aim of this study was to explore the experiences of nurses providing care to burned children regarding atraumatic care practices.

Method: This phenomenological qualitative study was conducted between March-July 2025 in the pediatric surgery department of training and research hospital in western Turkey. Fifteen nurses who had at least one year of experience in pediatric burn care were selected through purposive sampling. Data were collected via in-depth individual interviews using a semi-structured interview form and analyzed using inductive content analysis with the support of MAXQDA software.

Results: Analysis revealed one main theme, “Atraumatic Care for Injured Children,” comprising three categories and thirteen codes. Nurses reported employing strategies such as distraction, breastfeeding for infants, collaboration with families, providing age-appropriate explanations, and understanding children’s emotions during painful procedures like burn dressing. These practices were perceived to reduce fear and stress, decrease pain perception, alleviate psychological trauma, enhance treatment compliance, foster a sense of security, and increase patient-family satisfaction. Additionally, nurses recommended increasing the availability of distraction tools (e.g., toys, bubble machines, audiovisual devices) and arranging child-friendly physical environments to strengthen atraumatic care practices.

Conclusion: Atraumatic care is a key nursing approach that supports both the physical and psychological well-being of burned children. To improve care quality, it is recommended to provide supportive resources, increase the number of distraction tools, and design child-friendly care environments.

Examining the Relationship Between Occupational Fatigue and Health Perception Among Textile Factory Workers

Songül Dincer, Fatma Ersin — Mon, 22 Dec 2025 00:00:00 +0300

Objective: The study examined the relationship between occupational fatigue and health perceptions among workers in a textile factory.

Method: This descriptive study was carried out in textile factories. These were located in the Nusaybin district of Mardin. The study took place between October 2023 and October 2024. A total of 760 textile workers were included in the study. However, of those who agreed to participate in the study, only 654 were included in the sample. Data were collected using three forms: the Information Form, the Occupational Fatigue, Exhaustion and Recovery Scale, and the Health Perception Scale. The analysis of the data involved descriptive statistics, a t-test for independent groups, an analysis of variance and a correlation analysis. All the necessary permits have been obtained for the work to be carried out.

Results: The study found very weak relationships between health perception and chronic fatigue (r = .161, p = .000) and between perceived health and acute fatigue (r = .115, p = .003) among the subscales of the Occupational Fatigue, Burnout and Recovery Scale. A weak but significant relationship was found between health perception and the recovery sub-dimension (r=.299, p=0.000).

Conclusion: Therefore, proactive measures should be taken to reduce occupational fatigue levels among textile factory workers and encourage positive health perceptions.

Educational Quality of YouTube Videos on Endoscopic Submucosal Dissection: A LAP-VEGaS-Based Analysis

Vural Argın — Mon, 22 Dec 2025 00:00:00 +0300

Introduction: Endoscopic submucosal dissection (ESD) is a technically demanding procedure that requires advanced training, yet the educational quality and reliability of related YouTube content remain uncertain.

Objective: This study aimed to evaluate the educational quality of YouTube videos related to ESD using the LAP-VEGaS scoring system and to examine their association with viewer engagement metrics.

Methods: A cross-sectional study was conducted in November 2025 by searching YouTube with the keyword “endoscopic submucosal dissection,” yielding 26 eligible videos after applying predefined criteria. For each video, basic characteristics (upload date, duration, views, likes, dislikes, comments) and viewer interaction metrics (like rate, view rate, Video Power Index) were recorded. Two independent reviewers assessed educational quality using the nine-item LAP-VEGaS scoring system, classifying videos as high quality (HQ, ≥9 points) or low quality (LQ, <9 points). Statistical analyses were performed using SPSS 26.0, with p < 0.05 considered significant.

Results: Of the 26 analyzed videos, 13 (50%) were classified as HQ. HQ videos had significantly higher LAP-VEGaS scores than LQ videos (13.61 ± 1.98 vs. 4.15 ± 1.77, p < 0.001). HQ videos tended to be longer than LQ videos (1,262 ± 748 s vs. 1,028 ± 1,239 s, p = 0.064). The view ratio was significantly higher in LQ videos (p = 0.043). No significant differences were found between groups regarding total views, like ratio, or VPI.

Conclusion: The educational quality of ESD-related YouTube videos is inconsistent and often inadequate, underscoring the need for peer-reviewed, structured content to provide more reliable educational resources.

Effect of Spiritual Well-Being Level on Pain, Nausea and Vomiting in Patients Undergoing Cholecystectomy Surgery

Songül Güngör, Kezban Koraş Sözen, Havva Doğan Kırtıloğlu — Mon, 22 Dec 2025 00:00:00 +0300

Introduction: Spiritual well-being is considered an important component of holistic health and may influence patients’ perceptions of pain and other postoperative symptoms. Although cholecystectomy is a common surgical procedure, limited evidence exists regarding the role of spiritual well-being in the early postoperative recovery process. Understanding this relationship may guide nurses and clinicians in providing more individualized and holistic postoperative care.

Objective: This study aimed to examine the influence of spiritual well-being levels on early postoperative pain, nausea, and vomiting among patients who underwent cholecystectomy.

Methods: This descriptive study included 170 patients who underwent cholecystectomy. Data were collected using the Descriptive Characteristics Form, the Spiritual Well-Being Scale, and the Visual Analog Scale for pain intensity. Postoperative nausea and vomiting were assessed based on patient self-report during the early postoperative period.

Results: The mean age of the participants was 46.89±9.89 years, and 71.8% were women. The mean score on the Spiritual Well-Being Scale was 112.44±16.21, while the mean postoperative pain intensity measured by the Visual Analog Scale was 4.84±2.26. Analysis demonstrated that spiritual well-being was not significantly associated with postoperative pain levels, nausea, or vomiting.

Conclusions: The findings indicated that spiritual well-being did not influence early postoperative pain, nausea, or vomiting among patients who underwent cholecystectomy. These results suggest that spiritual well-being alone may not play a determining role in acute postoperative symptom experience. Further research involving different populations and longitudinal designs is recommended to explore the broader effects of spiritual well-being on surgical recovery.