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We aimed to evaluate the effect of different routes of norepinephrine (NE) administration on maternal hypotension in pregnant females undergoing spinal anesthesia for caesarean section. 208 pregnant women were divided randomly into 4 groups (n=52). Bolus 4 µg/ml NE was administered intravenous (iv) immediately after spinal anesthesia in Group PB (Prophylactic Bolus). In Group PI (Prophylactic Infusion), 1 ml of saline solution was applied promptly after spinal anesthesia and then the NE infusion was started at 1 ml/min. In Group TB (Treatment Bolus), 1 ml Physiological Saline (PS) was administered after 1 ml/min infusion of PS immediately after spinal anesthesia and then 1 ml/min NE bolus when blood pressure decreased by 20% after the entry. In Group TBI (Treatment Bolus Infusion), 1 ml PS was administered after 1 ml/min infusion of PS immediately after spinal anesthesia, 1 ml NE and then 1 ml/min NE infusion was initiated when blood pressure decreased by 20% after the entry. At the 4th, 6th, and 8th minutes, the PI Group exhibited higher systolic and mean blood pressures than the other groups (p<.001). Additionally, hypotension was statistically lower in the PI Group than in PB, TB, TBI groups (p<.001), and episodes of hypotension, ephedrine required and extra NE boluses given were statistically lower in the PI Group than in the other groups (p<.001). Umbilical vein (UV) pH values were lower in the TBI Group at compared to the other groups (p<.001). It is suggested that a prophylactic infusion of 4 µg/min of NE in the prevention of hypotension following spinal anesthesia for cesarean section will reduce the possibility of maternal hypotension and better maintain fetal well-being than a prophylactic bolus, a treatment bolus or a posttreatment bolus infusion at the same dose. [ABSTRACT FROM AUTHOR]

Acute Myocardial Infarction (AMI), a common disease that can have serious consequences, occurs when myocardial blood flow stops due to occlusion of the coronary artery. Early and accurate prediction of AMI is critical for rapid prognosis and improved patient outcomes. Metabolomics, the study of small molecules within biological systems, is an effective tool used to discover biomarkers associated with many diseases. This study intended to construct a predictive model for AMI utilizing metabolomics data and an explainable machine learning approach called Explainable Boosting Machines (EBM). The EBM model was trained on a dataset of 102 prognostic metabolites gathered from 99 individuals, including 34 healthy controls and 65 AMI patients. After a comprehensive data preprocessing, 21 metabolites were determined as the candidate predictors to predict AMI. The EBM model displayed satisfactory performance in predicting AMI, with various classification performance metrics. The model's predictions were based on the combined effects of individual metabolites and their interactions. In this context, the results obtained in two different EBM modeling, including both only individual metabolite features and their interaction effects, were discussed. The most important predictors included creatinine, nicotinamide, and isocitrate. These metabolites are involved in different biological activities, such as energy metabolism, DNA repair, and cellular signaling. The results demonstrate the potential of the combination of metabolomics and the EBM model in constructing reliable and interpretable prediction outputs for AMI. The discussed metabolite biomarkers may assist in early diagnosis, risk assessment, and personalized treatment methods for AMI patients. This study successfully developed a pipeline incorporating extensive data preprocessing and the EBM model to identify potential metabolite biomarkers for predicting AMI. The EBM model, with its ability to incorporate interaction terms, demonstrated satisfactory classification performance and revealed significant metabolite interactions that could be valuable in assessing AMI risk. However, the results obtained from this study should be validated with studies to be carried out in larger and well-defined samples. [ABSTRACT FROM AUTHOR]

Copyright of Turkish Journal of Trauma & Emergency Surgery / Ulusal Travma ve Acil Cerrahi Dergisi is the property of KARE Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Turkish Journal of Trauma & Emergency Surgery / Ulusal Travma ve Acil Cerrahi Dergisi is the property of KARE Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: There is no consensus on the optimal drainage technique in the management of biliary anastomotic strictures occurring after right-lobe living-donor liver transplantation (RL LDLT). Aims: To investigate whether there is a superiority between unilateral and bilateral drainage groups in terms of efficacy and safety of biliary drainage in RL LDLT patients undergoing double-biliary reconstruction. Study Design: Retrospective Cohort Methods: Between January 2009 and August 2019, 1693 patients underwent RL LDLT. Of these, 182 patients who developed biliary anastomotic strictures out of the 306 patients who had double-biliary reconstruction, were included in the study. One hundred fifty-five patients with technical success were divided into 2 groups as unilateral (n=116) and bilateral (n=39) drainage groups. The groups were compared in terms of variable parameters such as clinical success, additional procedure, post-ERCP complication, procedures after clinical failure, hospital stay, mortality, and survival. Results: The clinical success was higher in the bilateral group (70% vs. 82%, P = .201). In the initial and the follow-up periods, a total of 44 (38%) patients in the unilateral group were switched to the bilateral drainage group due to the increased need for stenting. The placement of a stent successfully solved the problem only in 28% (32/117) of the patients in the unilateral group, while this rate was 44% (17/39) in the bilateral group. The median follow-up time of both groups was 42 months, and was equal. The number of stent-free follow-up patients in the unilateral drainage group was less than that in the bilateral drainage group (4 and 7, respectively). Conclusion: An active attempt should be made for bilateral drainage in patients with biliary anastomotic stricture following RL LDLT. However, for patients in whom bilateral drainage is not possible, unilateral drainage may be recommended, with the placement of a maximum number of stents following primary biliary balloon dilatation, depending on the degree of stricture. [ABSTRACT FROM AUTHOR]

OBJECTIVE: In our study, the effects of the COVID-19 pandemic in Malatya province, other than confirmed case deaths, were investigated. MATERIAL AND METHODS: The records of those who died between 2016 and 2020 were reviewed on the official website of the Malatya Metropolitan Municipality, and the numbers of deaths in those 5 years were recorded on a weekly basis. The arithmetic mean of the deaths between 2016 and 2019 was calculated, and it was investigated whether the number of deaths in 2020 was more than expected. RESULTS: In 2020, 1743 (61%) excess deaths were detected. While the mean number of deaths reported 4 years before 2020 was 2860, it was determined that the number of deaths in 2020 was 4603, and there were 1743 (61%) excess deaths. CONCLUSION: The deaths occurred in Malatya during the COVID-19 pandemic were more than expected. It has been supposed that some deaths were of polymerase chain reaction negative and hence unrecorded COVID-19 patients' deaths, and some deaths were caused by other indirect effects of the pandemic. [ABSTRACT FROM AUTHOR]

Objective: In this study, it was aimed to develop a new user-friendly web-based software that would easily test single-variable univariate and multivariate normal distribution suitability and enable users to get more accurate results in their studies. Material and Method: Shiny, an open source R package, was used to develop the proposed web software. In the developed software, Shapiro-Wilk and Anderson-Darling tests were used for the uniformity of univariate distribution, and Mardia's skewness-kurtosis, Henze-Zircon and Doornik- Hansen tests were used for multivariate normal distribution. Outputs for conformity to normal distribution were supported by using graphical methods. In practice, for the data set where each variable consisting of two variables derived by simulation has a standard normal distribution and the variables contain 1000 observations, the normal distribution conformity analysis has been performed. Results: In the derived data set, each variable is normally distributed according to the Anderson-Darling and Shapiro-Wilk tests. (for x1 and x2 variables, respectively p =0.91 and p =0.707; p =0.756 and p =0.573). In addition, the derived data set showed two-variable normal distribution according to Mardia's skewness-kurtosis, Henze-Zircon and Doornik-Hansen tests. Conclusion: The developed software is a new user-friendly web-based software that can easily perform univariate and multivariate normal distribution conformity analysis and enable users to get more accurate results in their work. In further studies, Type I and Type II error types are planned to be included in the software in order to determine the best method. [ABSTRACT FROM AUTHOR]

This study was designed to identify and assess risk factors for portal vein thrombosis (PVT) in patients with cirrhosis. A total of 98 cirrhosis patients with PVT were identified and 101 cirrhosis patients without PVT were chosen as the control group in this retrospective study. Several variables were measured and the two groups PVT and non-PVT were compared statistically. PVT was identified in 98 patients (10%). Significant differences in hematocrit, international normalized ratio, albumin, bilirubin and glucose were determined between the groups (P<0.05). Out of the thrombophilic risk factors in the patients with PVT factor V Leiden was identified in 8.8%, prothrombin gene 6.6% and methylenetetrahydrofolate reductase 2.2%. There was no difference in survival time between groups (P>0.05). [ABSTRACT FROM AUTHOR]

Objective: The primary aim of this study is to examine and compare the classification performance of support vector machine mo dels generated by various core functions used to classify diabetes mellitus in acute coronary syndrome patients. The secondary aim is to optimize the parameters of the various kernel functions which are used for constructing the support vector machine mo del and to achieve the best classificat ion performance. Material and Method: The data examined in this study were selected retrospectively from the database developed for Inonu University Turgut Ozal Medical Center Cardiology Department. The study included type 2 diabetes mellitus and various demographic and clinical variables in acute coronary syndrome patients. The Support Vector Machine model was used to classify type 2 diabetes mellitus in acute coronary syndrome pat ients. The related models are constructed by ANOVA radial basis funct ion, bessel, linear, Gaussian radial basis funct ion, laplace, polynomial and sigmoid kernel funct ions. Results: The best classification performance was obtained by Support Vector Machine model const ructed by laplace kernel funct ion based on the results of performance metrics. The accuracy, area under ROC curve, sensit ivity and specificity met rics with 95% CI were calc ulated as; 0.9804 (0.9716 - 0.987), 0.9332 (0.9096 - 0.9567), 0.9999 (0.9791 - 1.000) and 0.9776 (0.9675 - 0.9852), respect ively. Conclusion: When the performance metrics were taken into account, the best classification per formance was achieved from the Laplace Support Vector Machine model. In subsequent studies, the use of Support Vector Machine models with different kernel functions and other machine learning or data mining algorithms in different clinical trials may improve the classification success of the diseases. [ABSTRACT FROM AUTHOR]

Background: Duodenal ulcer perforation is a serious condition. A number of methods have been defined and used in surgical treatment. In this study, it was aimed to compare the effectiveness of 'primary repair' and 'drain placement without repair' methods in duodenal perforations using an animal model., Methods: Three equivalent groups of ten rats each were formed. Perforation was created in the duodenum in the first (primary repair/sutured group) and the second group (drain placement without repair/sutureless drainage group). In the first group, the per-foration was repaired with sutures. In the second group, only a drain was placed in the abdomen without sutures. In the third group (control group), only laparotomy was performed. Neutrophil count, sedimentation, serum C-reactive protein (CRP), serum total an-tioxidant capacity (TAC), serum total thiol, serum native thiol, and serum myeloperoxidase (MPO) analyses were performed on animal subjects in the pre-operative period and on the post-operative 1st and 7th days. Histological and immunohistochemical (transforming growth factor-beta 1 [TGF-β1]) analyzes were performed. Blood analysis, histological, and immunohistochemical findings obtained from the groups were compared statistically., Results: There was no significant difference between the first and second groups, except for the TAC on the post-operative 7th day and MPO values on the post-operative 1st day (P>0.05). Although tissue healing was more pronounced in the second group than in the first group, there was no significant difference between the groups (P>0.05). TGF-β1 immunoreactivity observed in the second group was found to be significantly higher than in the first group (P<0.05)., Conclusion: We think that the sutureless drainage method is as effective as the primary repair method in the treatment of duo-denal ulcer perforation and can be safely applied as an alternative to the primary repair method. However, further studies are needed to fully determine the efficacy of the sutureless drainage method.

Aim: To reveal the relationships between patient findings and tissue resection in elderly patients., Materials and Methods: Between September 2020 and September 2022 three hundred eighty four patients over the age of 60 who were operated with the diagnosis of groin hernia were retrospectively analyzed. Gender, age, height, weight and body mass index value, groin and inguinal hernia types, hernia sides, primary or recurrent cases, hernia sac content, incarceration, tissue necrosis and resection presence, and accompanying pathologies were recorded. These findings were compared and evaluated in order to determine the relationships between patient findings and tissue resection, and the findings at risk for tissue resection., Results: Of the patients in the study, 352 (91.7%) were male and 32 (8.3%) were female. The mean age, height, weight and BMI were 67.48±5.893 years, 169.27±6.113 cm, 73.28±7.878 kg and 25,566±2.3518 kg/m2, respectively. There were 369 inguinal, 15 femoral, 285 indirect, 84 direct, 312 primary, and 72 recurrent hernias. Incarceration was present in 65 (16.9%) patients, 19 (4.9%) of these patients underwent resection due to tissue necrosis (twelve omentum and seven small intestine). Tissue resection was 3.1% in male, 25% in female, 4.3% in inguinal, 20% in femoral, 5.6% in indirect, 0% in direct, 3.5% in primary and 11.1% in recurrent hernias. Tissue resections were significantly higher in females, femoral hernias, indirect inguinal hernias and recurrent cases (p<0.05)., Conclusions: We can say that female gender, femoral, indirect and recurrent hernias are important risk factors for tissue resection in elderly patients., Key Words: Elderly Patients, Emergency Surgery, Groin Hernia, Incarceration, Tissue Resection.

Background: Appendicitis is one of the most common surgical emergencies among children. In this retrospective clinical study, we attempted to determine the effects of the COVID-19 pandemic period on hospital admission time and length of hospital stay (LOS) in pediatric appendicitis cases., Methods: We retrospectively compared pediatric appendectomies from the date of the first reported COVID-19 case to June 1, 2020, which is considered as the start of the normalization process, with pre-pandemic pediatric appendectomies of the same number of days in terms of age, gender, hospital admission time, LOS, parental educational level, laboratory values, and histopathological findings., Results: There was an average increase of 2 days in the time from the onset of symptoms to hospital admission in pediatric appen-dicitis patients in the COVID-19 period (p=0.001). Furthermore, C-reactive protein value was statistically significantly higher in the COVID-19 period (p=0.018). Given the LOS, it was calculated as an average of 5 days in the pre-pandemic period and 4 days in the COVID-19 period, and this difference was statistically insignificant (p=0.273). There was no significant difference between the groups in terms of histopathological findings (p=0.176). The parental educational level had no effect on the admission time., Conclusion: The hospital admission time of pediatric appendicitis patients is significantly prolonged in the COVID-19 pandemic, but this prolongation had no histopathological effect. During the pandemic, the recovery of patients who required urgent treatment during the 'stay-at-home' period was also negatively affected. Notwithstanding, we are of the opinion that the absence of an increase in the LOS may be due to the willingness of both families and physicians to keep the LOS as short as possible. Despite the increase in hospital admission time in pediatric appendicitis during the Covid 19 pandemic process, the lack of increase in the rate of complicated appendicitis may be an indicator of the importance of other factors in the development of complicated appendicitis.