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Pain control after breast surgery is crucial and supported with regional techniques. Paravertebral block (TPVB) is shown to be effective in postoperative pain management. Erector spinae plane block (ESPB) is assumed to have a similar analgesic effect as an easier and safer block. Our aim was to compare TPVB and ESPB for modified radical mastectomy (MRM) in terms of analgesic efficiency and dermatomal spread.Patients were randomized into Group E (ESPB) and Group P (TPVB). Total 83 patients completed study 42 in Group E and 41 in Group P. Blocks were performed under ultrasonography with 20 mL 0.375% bupivacaine at T4 prior to surgery. T1-10 dermatomal block was examined via pin-prick sensation on the midaxillary and midclavicular lines. Primary outcome was 24-hour morphine consumption. Dermatomal coverage, postoperative 0Morphine consumption was lower in Group P (19.2±2.9 vs. 21±3.1, P=0.007; mean difference 1.8 mg, 95%CI=0.48-3.1 mg). The number of dermatomes with total loss of sensation was higher in Group P. Pain scores were significantly lower in Group P at all time points. The incidence of complications and adverse events was similar in both groups.Thoracal paravertebral block reduced morphine consumption compared to ESPB after MRM, albeit a small difference. A through coverage of TPVB may be preferred with experienced operators in MRM due to lower pain scores.

Anesthesia management of pheochromocytoma excision surgery is associated with severe hemodynamic fluctuations. The objective of this study is to compare the number of hypertensive crisis requiring sodium nitroprusside (SNP) administration between the groups treated with magnesium (Mg)-dexmedetomidine (Dex) and conventional group in pheochromocytoma.This retrospective cohort study included patients who underwent pheochromocytoma surgery between 2011 and 2020. Patients were examined into two groups: 1-Conventional group (GC) included patients who were operated between 2011 and 2015 under standard anesthesia care and who did not receive perioperative additional medication. 2- Mg-Dex therapy group (GMD) comprised the patients who were operated between 2015 and 2020 and who had received 300 mg Mg per oral daily 1 week before the surgery and Mg-Dex infusion intraoperatively. Blood pressure, heart rate (HR), and SNP requirement were recorded throughout surgery as well as demographics and operative data. Hypertensive crisis was defined as systolic blood pressure (SBP)180 mmHg, and tachycardia was defined as HR110 bpm.A total of 78 patients' data were analyzed from 108 patients' documentary. (38 in GC, 40 in GMD) SNP requirement was significantly higher in GC (39.5%) comparing GMD (7.5%) (p=0.001). SBPs during tumor manipulation period were statistically higher in GC than in GMD at 10th, 15th, 20th, 25th, 30th, and 35th min. HR values were significantly higher in GC compared to GMD at 10th and 15th min of tumor manipulation period (p0.05).Combination of Mg-Dex seems to be an alternative therapy for reducing vasodilator requirement in perioperative management of pheochromocytoma.

Adolescent idiopathic scoliosis (AIS) is the most common type of scoliosis, and its treatment is essentially surgical for curves above 40 degrees. Posterior spinal instrumentation (PI) is the usual technique, while the vertebral body tethering (VBT) method is tested technique for this study as a new treatment option.To compare postoperative pain outcomes between PI and VBT with mini-thoracotomy surgeries performed in AIS patients.Prospective, randomized controlled study registered with the Clinical Trials Portal (NCT04822935).Department of Anesthesiology.We randomly divided 31 adolescents (28 women, 3 men) aged 11 to 18, with a diagnosis of AIS into 2 groups using computer software: the PI and the VBT groups. Postoperative morphine consumption and the Numeric Pain Rating Scale (NRS) scores at the 1st, 4th, 8th, 12th, 24th, and 48th hours and at 4 weeks were recorded. Length of hospital stays, length of intensive care unit (ICU) stays, duration of operation, postoperative patient satisfaction with the Likert scale, and complications such as bleeding and respiratory distress were recorded. Preoperative and follow-up Oswestry Disability Index (ODI) questionnaires were obtained to assess patient outcomes at 4 weeks postoperatively.Postoperative morphine consumption and the NRS scores at the 1st, 4th, 8th, 12th, 24th, and 48th hours were significantly higher in group VBT (P0.05). The amount of bleeding was significantly higher in group PI (P = 0.002). The ICU and the hospital length of stays in the VBT group were significantly higher (respectively, P = 0.011; P = 0.032). Discharge NRS scores, ODI scores as well as patients' satisfaction were similar in both groups (P0.05).Firstly, this was a single-centered study with a small sample owing to the rarity of AIS surgeries. Moreover, double-blinding was not applied to the patients and doctors because of the surgery incision places.From our results, both techniques can be employed for AIS surgery, but a meticulous approach is essential for the prevention of acute pain for VBT.

After congenital cardiac surgery, the duration of mechanical ventilation (MV) is related to the clinical status, type of operation, and the sedative-analgesic agents used postoperatively. This study aims to examine the effects of dexmedetomidine and morphine on the fast-track extubation (FTE) and ultra-fast-track extubation (UFTE) protocol after congenital cardiac surgery.A total of 251 pediatric patients were divided into two groups: 118 patients in the morphine group (Group M) and 133 patients in the dexmedetomidine group (Group D). We retrospectively reviewed medical data including hemodynamic parameters, duration of MV and cardiovascular intensive care unit (CICU), additional sedative/analgesic requirement, adverse events, the need for reintubation, and noninvasive MV, sedation, and pain scores.The mean mechanical ventilation duration of Group D was significantly shorter than Group M (3.74 ± 0.83 h in Group D, 5.72 ± 1.54 h in Group M, respectively) (p = .001; p .05). In Group D, the success rate of FTE was 92.5% (n = 123) and UFTE was 7.5% (n = 10) (p = .001). In Group M, the success rate of FTE was 72.9% (n = 86) and UFTE was 0% (n = 0) (p .05).Dexmedetomidine and morphine have clinical benefits which encourage their use for FTE protocol. Dexmedetomidine has more benefits compared to morphine. It can be used in UFTE protocol, besides its use in FTE protocol with fewer side effects.

Background: This study examines the frequency of problematic internet use and sleep problems in adolescents aged 14–18 years during the COVID-19 pandemic and identifies the impact of factors such as sociodemographic characteristics, internet habits, changes in daily life, and perceived social support on these problems. Methods: This multicentre study was a questionnaire-based online survey study. The questionnaire included the Young Internet Addiction Scale, the Pittsburgh Sleep Quality Index, and the Multidimensional Scale of Perceived Social Support, as well as questions about demographic information, internet habits, and changes in daily life during pandemic. Several multivariate Backward logistic regression models were run to determine the variables that predicted problematic internet use and poor sleep quality. Results: It was determined that the frequency of problematic internet use was 15.5%, and the frequency of poor sleep quality was 47.8%. Poor sleep quality was found 2.5 times higher in problematic internet users. The perceived social support was found insufficient in adolescents with problematic internet use and poor sleep quality. Various factors such as the excessive use of internet and social media, low school success, lack of physical activity, lack of rules for internet use at home, and worsening of relationships with parents were found to be predictive factors for these problems. Conclusions: Problematic internet use during the pandemic is associated with worsening sleep quality in adolescents. It is important to create special interventions for problematic internet use and sleep problems that develop in adolescents as a result of restrictions during the pandemic. © 2022 Association for Child and Adolescent Mental Health.

Objective: To evaluate the characteristics of the patients who were followed-up with the diagnosis of ataxia telangiectasia (AT) and to assess the relationship between the hyper IgM (HIGM) phenotype and their prognosis. Materials and Methods: From 2007 to 2019, the study included 68 patients aged 3-35 years who were followed-up with the diagnosis of AT. We retrospectively evaluated the clinical and immunological characteristics and follow-up results. Results: There were 36 girls and 32 boys with a median follow-up of 10 years (1-12 years). The most common complaints upon admission were unsteady walk in 87%, infection in 6%, presence of a family history in 6%, and intracranial mass in 1%. The marriage was consanguineous in 85% of the parents. Ataxia was seen in 100% of the patients, telangiectasia in 97%, and immune deficiency in 88%. Bronchiectasis was observed in 23.5% of the patients, chronic diarrhea in 19%, lymphoproliferation in 15%, malignancy in 10%, autoimmunity in 10%, liver failure in 6%, and granulomatous skin lesions in 6%. Thirteen patients (19%) died during follow-up. The HIGM phenotype was identified in 31% of the patients. Recurrent upper and lower respiratory tract infections (p=0.004 and p

Background and Aim of the Study Transfusion-associated hyperpotassemia is a serious complication of packed red blood cell (PRBC) transfusion after congenital cardiac surgery. Our study aimed to identify risk factors and potential preventive measures of transfusion-associated hyperpotassemia in neonates and infants after congenital cardiac surgery. Methods Pediatric patients who underwent congenital cardiac surgery and need transfusion were enrolled in this prospective study. The potassium concentration of PRBC was checked from the sample taken from the segment. The volume of transfusion, age of PRBC, potassium concentration of unit were recorded. The estimated increment of potassium level in patients after PRBC transfusion was calculated. Results Seventy-four individual patients, 95 distinct transfusions, 112 blood products were evaluated. The mean age of the blood unit was 3.8 +/- 1.4 days. The mean potassium concentration in the PRBCs was 9.9 +/- 2.4 mmol/L. A weak correlation was observed between the potassium value of the PRBC and the age of PRBC (p = 0.049, r = 0.2, y = 0.24 x x + -0.68). There was a weak correlation between the potassium value of PRBCs and the age of the unit (p < 0.001, r = 0.37, y = 2.8 x x + -3.6). Conclusions Before transfusion, even PRBC is fresh, measuring the potassium level of PRBC and the potassium that will be given to the pediatric patient with transfusion can prevent transfusion-related hyperpotassemia and related complications. Otherwise, high potassium levels, which may be overlooked despite being fresh, may cause serious complications, even cardiac arrest, especially in neonates and infants.

Familial Mediterranean fever (FMF) is an autosomal recessively inherited disorder characterized by recurrent fever and attacks of abdominal pain, chest pain, and joint pain. Attacks of recurrent fever and serositis are encountered clinically. Attacks may present either with only one symptom or many simultaneous symptoms. Although most of the patients are diagnosed clinically above the age of 2, those cases who are diagnosed before 2 years of age and with clinical course of isolated fever are believed to have a more serious course and tend to develop amyloidosis. In this article, a case who was admitted first on the 22nd day of life and later diagnosed to have FMF with recurrent attacks of isolated fever and no other focus is presented. We emphasize that FMF may present as early as in the first month of life, and it should be considered in cases presenting with fever of unknown origin and misdiagnosed to have late neonatal sepsis or occult bacteremia at this age group.

INTRODUCTION The aims of this randomized prospective mannequin study were to determine the amount of attempts required for successful intubation using different fiberscopes (Bonfils and SensaScope) by inexperienced anesthesiologists in a difficult airway scenario and to build the associated learning curves. METHODS Difficult airway simulation was achieved with tongue edema in mannequin. After approval of volunteers, we asked 15 anesthesiology residents without any experience with fiberscopes to intubate with each device in a random order. Intubation success (endotracheal intubation within 120 seconds), the degree of difficulty of intubation, and reality of simulation using a 10-point scale were recorded. Learning curves were generated with cumulative sum method. RESULTS With Bonfils, 13 volunteers were able to pass lower decision boundary with a median number of 26 [95% confidence interval (CI) = 21.4-25.9] attempts, whereas in SensaScope, the same outcome was observed in 10 residents with a median number of attempts of 26 (95% CI = 23.5-32.5). Total success rate was found significantly higher with Bonfils compared with SensaScope (550/600 vs 512/600, respectively, P < 0.001). Intubation with Bonfils was considered as less difficult compared with SensaScope [median = 4 (95% CI = 3.32-4.42) and 6 (95% CI = 4.96-6.64), P = 0.01, respectively]. The reality of the simulation was rated as a median of 5 (95% CI = 4.37-5.8). CONCLUSIONS Although a similar number of attempts were required to reach predetermined competency for both fiberscopes, only 10 of residents were able to obtain the targeted success using SensaScope as compared with 13 with Bonfils. Inexperienced residents found intubation via Bonfils less difficult than SensaScope. High individual variability in obtaining competency observed in this study with cumulative sum analysis underlines the importance of defining success a priori to simulation, the need for follow-up of individual progress, and the need to offer adequate trials to achieve competency. Therefore, learning opportunities should be adapted accordingly.

Resumo Justificativa e objetivos A proporcao entre neutrofilo/linfocito e um indicador de inflamacao simples, custo‐efetivo e de facil aplicacao que vem sendo usado com frequencia em estudos de mortalidade, morbidade e prognostico nos ultimos anos. Avaliamos a relacao entre a proporcao neutrofilo/linfocito e a dor pos‐operatoria em pacientes submetidos a artroplastia total de quadril e artroplastia total de joelho. Material e metodos No total, 101 pacientes que preferiram a raquianestesia e a analgesia venosa controlada pelo paciente foram incluidos e divididos em dois grupos neste estudo: artroplastia total de quadril e artroplastia total de joelho. Os dados demograficos e os tempos de operacao, internacao hospitalar e consumo de analgesicos e os resultados da proporcao neutrofilo/linfocito e da dor pos‐operatoria foram registrados usando uma escala visual analogica. Resultados O consumo de morfina dos pacientes submetidos a artroplastia total de quadril e artroplastia total de joelho nas horas 4, 8, 12, 24 e 45 foi de, respectivamente: 7,38 mg e 7,80 mg; 12,19 mg e 13,29 mg; 16,94 mg e 19,18 mg; 25,97 mg e 27,98 mg; 36,38 mg e 39,59 mg. Os escores obtidos na escala visual analogica dos pacientes submetidos a artroplastia total de quadril e artroplastia total de joelho nas horas 4, 8, 12, 24 e 48 foram, respectivamente: 4,10 e 4,51; 3,02 e 3,43; 2,29 e 2,55; 1,90 e 1,87; 1,08 e 1,13. Na artroplastia total do quadril, uma associacao estatisticamente significativa foi encontrada entre a proporcao neutrofilo/linfocito no pos‐operatorio e os valores da escala visual analogica na 48a hora em uma direcao positiva (r = 0,311; p = 0,031; p Conclusao A proporcao neutrofilo/linfocito pode ser aceita como um metodo relativamente objetivo para o diagnostico da dor pos‐operatoria.

Background and objectives: Neutrophil to lymphocyte ratio is a simple, cost-effective and easily applicable inflammation indicator that is being used frequently in mortality, morbidity and prognosis studies in the recent years. We evaluated the relationship between neutrophil to lymphocyte ratio and postoperative pain in patients undergoing total hip arthroplasty and total knee arthroplasty. Material and methods: We included 101 patients who preferred spinal anesthesia and intravenous patient-controlled analgesia in accordance and divided them into two groups, total hip arthroplasty and total knee arthroplasty. We recorded demographic information, duration of operation, length of hospital stay, analgesics consumption, neutrophil to lymphocyte ratio results and postoperative pain using Visual Analog Scale. Results: The morphine consumption of the patients was as follows in group total hip arthroplasty and total knee arthroplasty: at the 4th hour: 7.38 mg, 7.80 mg; 8th hour: 12.19 mg, 13.29 mg; 12th hour: 16.94 mg, 19.18 mg; 24th hour: 25.97 mg, 27.98 mg; 48th hour: 36.38 mg, 39.59 mg. The Visual Analog Scale scores of the patients was as follows in group total hip arthroplasty and total knee arthroplasty: at the 4th hour: 4.10, 4.51; 8th hour: 3.02, 3.43; 12th hour: 2.29, 2.55; 24th hour: 1.90, 1.87; 48th hour: 1.08, 1.13. In group total hip arthroplasty, we found a statistically significant association between postoperative neutrophil to lymphocyte ratio and the Visual Analog Scale values on the 48th hour in a positive direction (r = 0.311; P = 0.031; P

Objective In this prospective randomized study, we aimed to evaluate the effect of tracheal intubation with four different laryngoscopes [Macintosh direct laryngoscope-classic laryngoscope (CL), McCoy (MC), C-Mac video-laryngoscope (CM) and McGrath video-laryngoscope (MG)] on haemodynamic responses in patients with a normal airway. Methods One hundred and sixty patients were included. Succeeding haemodynamic measurements were performed immediately after intubation (T2) and for 5 min with 1-min intervals (T3-T4-T5-T6-T7). The primary outcome was the heart rate (HR) and systolic blood pressure (SBP) change triggered by the four different laryngoscopes. The intubation time, the number of intubation attempts, need for stylet or additional manipulation, glottic view and traumatic complications caused by intubation procedure were recorded as secondary outcomes. Results HR values significantly increased with the completion of laryngoscopy and intubation at T2 for the CL, MC and CM groups. Lesser fluctuation in HR and SBP was observed in the MG group. Intubation time was significantly shorter in the MG group (p

Objective Microlaryngeal surgery requires teamwork between surgeons and anesthesiologists. High-frequency jet ventilation (HFJV) is an artificial breathing technique, preferred during endolaryngeal interventions, which offers a good solution for the requirements. Most studies investigating independent risk factors for intraoperative complications during HFJV in endolaryngeal surgery (ELS) has been retrospective and not standardized and the anesthetic approach has not been standardized. This prospective cohort study aimed to identify risk factors of complications related to HFJV in ELS under a standardized anesthesia regimen. Methods 243 patients who underwent ELS with infraglottic HFJV were investigated. Infraglottic jet ventilation catheter was placed and anesthesia was standardized. Demographic and operative data were noted. Hemodynamics, SpO2 and end-tidal CO2 were recorded at regular intervals. Complications such as hemodynamic disturbances, respiratory problems, barotrauma, equipment failure and requirement for conventional ventilation were also documented. Results 222 patients were included. Hypoxia, hypercapnia and the need for intubation were observed in 20(9%), 4(1.8%), 10(4.5%) patients. Bradycardia, hypotension and arrhythmia were observed in six (2.7%), 24(10.8%), and four (1.8%) patients respectively. Respiratory complications were associated with body mass index (BMI) (p < 0.001, OR: 1.57, 95%CI: 1.31–1.88) and previous major airway surgery (p < 0.001, OR: 34.0, 95%CI:3.52–328.24), whereas hemodynamic complications were associated with duration of the operation (p = 0.034, OR:1.04, 95%CI:1.0–1.09) and history of previous major airway surgery (p = 0.005, OR:9.57, 95%CI:1.97–46.49). Conclusion Infraglottic HFJV can be evaluated as an alternative breathing technique to conventional ventilation during endolaryngeal interventions. However, longer operation and previous laryngeal surgeries can increase the incidence of respiratory complications.

Sağır, Özlem (Balikesir Author), Introduction More than 300 million surgical procedures are performed each year. Acute kidney injury (AKI) is a common complication after major surgery and is associated with adverse short-term and long-term outcomes. However, there is a large variation in the incidence of reported AKI rates. The establishment of an accurate epidemiology of surgery-associated AKI is important for healthcare policy, quality initiatives, clinical trials, as well as for improving guidelines. The objective of the Epidemiology of Surgery-associated Acute Kidney Injury (EPIS-AKI) trial is to prospectively evaluate the epidemiology of AKI after major surgery using the latest Kidney Disease: Improving Global Outcomes (KDIGO) consensus definition of AKI. Methods and analysis EPIS-AKI is an international prospective, observational, multicentre cohort study including 10 000 patients undergoing major surgery who are subsequently admitted to the ICU or a similar high dependency unit. The primary endpoint is the incidence of AKI within 72 hours after surgery according to the KDIGO criteria. Secondary endpoints include use of renal replacement therapy (RRT), mortality during ICU and hospital stay, length of ICU and hospital stay and major adverse kidney events (combined endpoint consisting of persistent renal dysfunction, RRT and mortality) at day 90. Further, we will evaluate preoperative and intraoperative risk factors affecting the incidence of postoperative AKI. In an add-on analysis, we will assess urinary biomarkers for early detection of AKI. Ethics and dissemination EPIS-AKI has been approved by the leading Ethics Committee of the Medical Council North Rhine-Westphalia, of the Westphalian Wilhelms-University Münster and the corresponding Ethics Committee at each participating site. Results will be disseminated widely and published in peer-reviewed journals, presented at conferences and used to design further AKI-related trials. Trial registration number NCT04165369. ©

To compare the course of the transcutaneous bilirubin (TcB) values of early-term newborns with those of term newborns in the first month of life and to investigate whether early-term newborns have an increased risk of significant hyperbilirubinemia requiring treatment.A prospective, controlled cohort analysis.A tertiary level mother-child birth and health care center.Four hundred early-term (37 0/7 to 38 6/7 weeks) and 320 term (39 0/7 to 41 6/7 weeks) newborns born during a 27-month period.A total of six TcB measurements in a longitudinal manner were made in early-term and term newborns: the first two at 6 and 48 hours after birth and the next four on routine examination days (Days 4, 7, 15, and 30). Demographic characteristics, values of daily TcB measurements, number of newborns with significant hyperbilirubinemia, and risk of jaundice requiring treatment were compared between the two groups.All six TcB values were significantly greater in the early-term group than in the term group (p .001 for each). Early-term newborns had a statistically significant increased risk of jaundice requiring treatment compared to term newborns (risk ratio = 1.91; 95% confidence interval [1.23-2.96]; p = .0046). Results of the repeated-measures analysis of variance and post hoc adjusted multiple comparison analysis showed that TcB levels increased to and peaked at 96 hours after birth and then gradually decreased to baseline (first measurement) levels at 30 days after birth in each group.Early-term newborns should not be treated as full-term newborns because they have significantly higher TcB levels. These newborns should be closely monitored for pathologic jaundice because they have increased risk for significant hyperbilirubinemia requiring phototherapy.

INTRODUCTION: The aim of this study is to test the usefulness of epiphysis of distal radius measurement as a surrogate parameter for endotracheal tube (ETT) size prediction in children. METHODS: Seventy-three children were intubated with cuffed ETT selected according to age-based formula. Transvers diameter of epiphysis of distal radius and subglottic diameter of trachea were measured by ultrasound (US). Correlation between the outer diameter of best-fit endotracheal tube and transvers diameter of both radius epiphysis and subglottic diameter were calculated. The need for tube exchange, time for ultrasound (US) measurements and the ease level of measurements were compared. RESULTS: First attempt success at intubation was 83.6%. The correlation of the epiphysis diameter of the distal radius and best-fit ETT was significant (p

Loss-of-function (LOF) mutations in signal transducer and activator of transcription 3 (STAT3) gene causes autosomal dominant hyper immunoglobulin E syndrome (AD-HIES or Job’s Syndrome), a rare and complex primary immunodeficiency (PID) syndrome characterized by increased levels of IgE (>2000 IU/mL), eosinophilia, recurrent staphylococcal skin abscesses, eczema, recurrent pneumonia, skeletal and connective tissue abnormalities. Although bacterial and fungal infections are common in AD-HIES, susceptibility to parasitic infections has not been reported. Alveolar echinococcosis (AE), a zoonosis caused by the growth of the Echinococcus multilocularis (EM) metacestode, mimics slow-growing liver cancer. The mortality rate of AE is very high when it is diagnosed late or under-treated. Here, we report a 14-year-old boy with AE infections of the liver and the lung resulting in liver failure and diagnosed as STAT3-LOF. To our knowledge, the association between these two conditions has not been reported in the literature before.

Objectives Pre-operative airway evaluation is essential to decrease the proportion of possible mortality and morbidity due to difficult airway (DA). The study aimed to evaluate the accuracy of pre-operative ultrasonographic airway assessment (UAA) and indirect laryngoscopy (IL) in predicting DA. Study design Prospective obsevational study. Methods Preoperative clinical examination (body mass index [BMI], mallampati classification [MP], thyromental distance, sternomental distance, neck circumference), UAA (epiglottis-skin distance [ESD], hyoid bone-skin distance [HSD], the thickness of tongue root [ToTR], anterior commissure-skin distance [ACSD]) and IL with the rigid 70-degree laryngoscope were performed to predict DA (Cormack-Lehane grade 3 and 4). The sensitivity, specificity, positive predictive value (PP), and negative predictive values of the parameters were assessed. Results Twenty-two of 140 (15.7%) patients were diagnosed with DA. The cut-off points of ESD, HSD, ToTR, ACSD, and BMI were 2.09 cm, 0.835 cm, 4.05 cm, 0.545 cm, and 27.10, respectively. AUC values were 0.874, 0.885, 0.871, 0.658, and 0.751 in the same order. AUC values for IL and MP were 0.773 and 0.925, respectively. MP and HSD had the best sensitivity (91%), IL grading had the best specificity (100%), and PP (100%) value among all measurements. The best-balanced sensitivity (91%), specificity (97%), and PP (88%) values were obtained by combining the IL with MP and ESD or with MP and HSD. Conclusions Ultrasonographic measurements and IL were found significantly correlated to predict DA. Combined parameters, the IL with MP and ESD or with MP and HSD, are the best parameters in predicting the DA. Level of evidence 4 Laryngoscope, 131:E555-E560, 2021.

Bu yazıda indirekt hiperbilirubinemi tanısı ile tetkik edilen, etiyolojiye yönelik ilk incelemelerde Rh uygunsuzluğu ve direkt Coombs pozitifliği saptanan, ileri incelemelerde anne ile bebek arasında C minör kan grubu uygunsuzluğu ve bebekte anti C antikorlar pozitif saptanarak anti C minör kan grubu uygunsuzluğuna bağlı indirekt hiperbilirubinemi tanısı konan bir yenidoğan sunulmuştur. Eş zamanlı Rh uygunsuzluğu ve direkt Coombs pozitifliği ile beraber hafif-orta şiddette hiperbilirubinemi bulunan olgularda tanıda ilk akla gelen Rh uygunsuzluğundan ziyade minör kan grubu uygunsuzluğu gibi izoimmünizasyonun diğer nadir nedenlerinin araştırılmasının gerekliliği vurgulanmıştır.

BACKGROUND Although the relationship between umbilical cord clamping time and various parameters such as hemoglobin (Hb) levels, iron deficiency, and risk of neonatal jaundice has previously been studied, to the best of our knowleadge there have been no studies investigating the relationship between cord clamping time and the risk of significant hyperbilirubinemia. We aimed to investigate the relationship between the time of umbilical cord clamping and transcutaneous bilirubin (TcB) measurements made on various postnatal hours, Hb and serum total bilirubin (STB) levels measured on postnatal 4th day, and the risk of development of significant hyperbilirubinemia requiring phototherapy treatment. METHODS Eligible newborns were divided into two groups on the basis of the time of cord clamping: those clamped late (60 seconds or more; Group I) and those clamped early (less than 60 seconds; Group II). Groups were compared with respect to the parameters of cord Hb, postnatal TcB measurements at 6th, 48th, 96th and 168th hours, and 96th hour Hb, STB and direct bilirubin levels. RESULTS TcB levels at the 96th and 168th hour were significantly higher in Group I when compared to Group II (p < 0.001 and p < 0.001, respectively). The 96th hour STB level was significantly higher in Group I when compared to Group II (p < 0.001). The need of phototherapy requirement was higher in Group I when compared to Group II (p=0.001). Increase in cord blood Hb for each 1 gr/dl caused a 3.94-fold increased risk in the requirement of phototherapy treatment. Cord clamping time showed statistically significant positive correlations with both cord blood and 96th hour venous Hb levels, with both 96th hour and 168th hour TcB levels, and with 96th hour STB levels. CONCLUSIONS Newborns whose cords are clamped late should be followed up closely with respect to high postnatal bilirubin levels and other risks associated with significant hyperbilirubinemia requiring phototherapy treatment.

We documented brachial plexus injury by electromyography and magnetic resonance imaging secondary to needle sticks for central line insertion. This type of complication is rare in the literature, as few case reports exist. Brachial plexus injury can happen because of anatomic variations. Nevertheless, multiple attempts or introducer needle rotations should be avoided during subclavian vein catheterization. Pain that emerges in the ipsilateral arm after subclavian catheter placement should be taken into serious consideration. It is important to identify the cause of pain as soon as possible so that the correct treatment can be efficiently provided. Use of an ultrasound-guided catheterization may be a better choice for preventing complications.

SummaryBackground The aim of this prospective study was to investigate the success of ultrasound in pediatric patients in determining the appropriate sized cuffed endotracheal tube and to compare the results with conventional height-based (Broselow) tape and age-based formula tube size. Methods One hundred and fifty-two children of 1-10 years of age, who received general anesthesia for adenotonsillectomy were enrolled to the study. In all participants, the transverse diameter of the subglottis was measured with ultrasound during apnea. An endotracheal tube was chosen with the outer diameter matched to the measured subglottic airway diameter. An age-based (Motoyama-Khine) and height-based (Broselow) endotracheal tube size was calculated. If there was resistance to passage of the tube into the trachea or an airway pressure >25 cmH20 was required to detect an audible leak, the endotracheal tube was replaced with internal diameter of 0.5 mm smaller. If there was an audible leak at airway pressure 25 cmH20 or a cuff pressure > 25 cmH2O was required to seal, the tube was changed to the 0.5 mm larger internal diameter. Best-fit tube internal diameter was the resultant tube internal diameter that met the previously stated conditions. The need for endotracheal tube replacement and peak airway pressure were recorded. Results The internal diameter of ultrasound determined tube was the same as best-fit tube in 88% of children. Endotracheal tube was replaced in 15 patients with a one size larger, and in three patients with one size smaller tube. Using Bland-Altman analysis, a better agreement was observed with ultrasound measurement rather than height-based estimation and age-based formulas. Conclusion Our findings show that subglottic diameter measured by ultrasound appears to be a reliable predictor for the assessment of the subglottic diameter of the airway in estimating appropriate size pediatric endotracheal tube.

Background Hypotension after anesthesia induction is a common problem and is partly related to patient volume status. The present study aimed to investigate the correlation between blood pressure change and pulse pressure variation (PPV), and percentage of weight loss while determining threshold for hypotension by receiver operating characteristic analysis. Methods We analyzed 231 neurosurgery patients. In all patients, propofol was used for standard anesthesia induction. Patient demographics, medical histories, fasting duration, percentage weight loss, baseline blood pressure, and PPV during normal tidal volume breathing and that during forced inspiratory breathing (PPVfi) were recorded. Hemodynamic changes within 10 minutes of intubation were observed. Patients developing hypotension and severe hypotension were determined; lowest mean arterial pressure (MAP) and systolic arterial pressure (SAP) values were recorded, and their differences relative to baseline values were calculated. Results The incidence of hypotension was 18.6%. Both percentage weight loss and PPVfi were correlated with the changes in MAP and SAP. A PPVfi>14 identified all observed hypotensive episodes with 86% sensitivity and 86.2% specificity, whereas percentage weight loss >1.75% identified all observed hypotensive episodes with 81.4% sensitivity and 70.7% specificity. Furthermore, PPVfi>16.5 identified severe hypotension with 85% sensitivity and 90.5% specificity, whereas percentage weight loss >1.95% identified severe hypotension with 85% sensitivity and 73% specificity. Conclusions Percentage weight loss and PPVfi are good predictors of hypotension after anesthesia induction and, thus, may allow anesthesiologists to adopt preventative measures and ensure safer anesthesia induction.

Objective The aim of this feasibility study was to investigate the first attempt success of ultrasonography (USG) in paediatric patients in predicting an appropriate cuffed endotracheal tube (ETT) size. Methods Fifty children who were 1-10 years of age and who received general anaesthesia with endotracheal intubation for adenoidectomy or adenotonsillectomy were enrolled in the study. In all participants, the transverse diameter of the subglottic airway was measured with USG at the cricoid level without ventilation. The outer diameter (OD) of the maximum allowable ETT was chosen according to the measured subglottic airway diameter. In the presence of resistance to passage of the tube into the trachea or in the absence of an audible leak at airway pressure of >25 cm H2O, the ETT was replaced with a tube whose internal diameter (ID) was 0.5 mm smaller. If a leak was audible at airway pressures of 25 cm H2O or if a peak airway pressure of >25 cm H2O was observed during ventilation, the tube was changed to a tube one size larger. The OD of the best-fit ETT was converted to the ID. The best-fit ID, the requirement for ETT replacement, the duration of airway diameter measurement by USG and the peak airway pressure were recorded. Results The success rate of the first attempt with USG was 86%; the ETT was replaced in five patients with a tube one size larger and in two patients with a tube one size smaller. Conclusion Our findings show the subglottic diameter measured by USG to be a reliable predictor in estimating the appropriate paediatric ETT size.

Introduction: Frequent infection is located in the first place among the reasons for the application polyclinic in infancy and pre-school. The aim of this study is to evaluate the insidence of allergic disease in patients who apply to our allergy-immunology clinic for frequent infectious diseases and diagnosed with immunoglobulin isotype deficiency. Material-Method: The medical records of 2592 patients who have complaint of frequent infection attended to Department of Pediatric Immunology-Allergy, *** University School of Medicine between January 2013 and February 2016 were investigated as retrospectively. Results: 258 (9.9%) of the patients had immunoglobulin isotype deficiency. Age range was 6-204 months. 151 (58.5%) were male, 107 (41.5%) were female. 17% had parental consanguinity. The diagnosis of patients: 12 (4.6%) selective IgA deficiency, 31 (12%) partial IgA deficiency, 53 (20.5%) isolated IgM deficiency, 117 (45.3%) transcient hypogammaglobulinemia of infancy. 33 (12.7%) considered as prolonged hypogammaglobulinemia and 12 (4.6%) unclassified hypogammaglobulinemia. 173 (67%) patients had an allergic disease besides immunoglobulin isotype deficiency diagnosis. The allergic diagnosis of patients were; 90 asthma, 66 atopic dermatitis, 47 allergic rhinoconjunktivitis and 44 transcient wheezing of infancy. There was no statistical difference between isotypes about co-insidence of allergic disease and immunoglobulin deficiency (p=0.83). Conclusion: Rate of accompanied by an allergic disease regardless of the type of immunoglobulin isotypes deficiency had been high in our patients. Keep in mind and investigate surely of immunodeficiency may be combined with recurrent infection and atopy in patients whom admitted with allergy symptoms is important for appropriate management of treatment.

In this study, we evaluate 25 cases who were admitted to the emergency service and transferred to the intensive care unit subsequently due to snakebite, prospectively. Clinical courses, toxic effects, complications and treatment approaches were aimed to be presented. Among the patients, 16 were female and 9 were male; the mean age was 42.1 (17-74 years). It was determined that all the cases were admitted to the hospital during working in the field in Eastern Anatolia Region, between the months of May and June, and between the hours of 15:00 to 18:00. When the cases were considered in terms of bitten body part, 15 were bitten from upper extremity and 10 were bitten from lower extremity. Within an hour the patients were admitted to a health facility with the complaints of nausea, pain, numbness, swelling and redness, and patients were transferred to emergency unit approximately within 1 hour (0.5 to 2 hours) following the first intervention. Tetanus immunization is administered in all cases as the first intervention. Antivenom was administered to the 9 (36%) of the patients in whom steroid, antihistamine and prophylactic antibiotic therapy was given in the intensive care unit. Under the control of infection clinic, antibiotic therapy was initiated to 13 (52%) patients in who cellulitis, abscess, lymphedema and compartment syndrome were developed. Healing was observed approximately within 4 days (2-6 days) and recovery was observed in all the cases. Patients admitted due to snake bites should be followed closely for at least 6 to 8 hours. According to the patient’s clinical condition and laboratory test results, early intervention therapy should be regulated and antivenom therapy should be administered in the presence of systemic symptoms.

The aim of this study was to investigate the success rates of ultrasound (US) and palpation methods in identifying the cricothyroid membrane (CTM), and compare the results with the gold standard method-computed tomography (CT) scan.A total of 110 patients were included into the study. The midline was estimated by a single investigator using both the US and palpation methods from the prominence of the thyroid cartilage to the center of the sternal notch, and the distance was measured (in millimeters) between the two points: Point A (the midpoint of CTM) and Point B (the inferior process of thyroid cartilage). Furthermore, the distance between Point A and Point B was calculated using the CT images. Time taken to assess the CTM by using US and palpation methods were recorded. Moreover, difficulty in using the two methods was measured with the visual analog scale (VAS). In addition, demographic and morphometric characteristics of the patients were noted.The CTM was detected accurately in 50 (45.5%) patients with palpation and 82 (74.5%) with US. In the Bland-Altman analysis, a better agreement was observed with US. The time to assess CTM was shorter with US than with palpation, p0.001. The VAS scores for the palpation and US difficulty were 5.13+-1.1 and 3.32+-0.9 (p0.001), respectively. While an increased neck circumference and thyromental distance were found to be independent risk factors for the success rates of determining the CTM by palpation, body mass index is an independent risk factor for US.Localization of the CTM is more accurate and easier with US than palpation. Furthermore, the results gathered with US are in a closer range to CT scan.

Background Endotracheal tube size can be predicted according to ultrasound measurement of subglottic airway diameter. The learning curve for this method is not yet established. The aim was to evaluate the learning curve of anesthesiology residents in ultrasound measurement of subglottic airway diameter for prediction of endotracheal tube size using cumulative sum analysis. Methods Sixteen anesthesiology residents measured transverse subglottic airway diameter in children undergoing general anesthesia with cuffed endotracheal intubation. Each resident performed 30 ultrasound examinations. Primary outcome was the successful prediction of endotracheal tube size according to ultrasound measurement. Cumulative sum analysis was performed with acceptable and unacceptable failure rates set as 20 and 40%, respectively. Results Ten out of 16 residents (62.5%) were deemed successful as they were able to pass lower decision boundary, whereas six residents' CUSUM scores were between the decisions lines deeming them indeterminate. The overall success rate for determining the correct endotracheal tube size was 77.5%. Median number of attempts to cross lower decision boundary was 29 with minimum of 18 and maximum of 29 attempts among successful residents. Conclusion Learning curves constructed with cumulative sum analysis in this study showed that only 62.5% of residents were able to correctly predict cuffed endotracheal tube size with 80% success rate. Considerable variability in achieving competency necessitates objective follow-up of individual improvement.

BACKGROUND The aim of this study was to investigate the success rates of ultrasound (US) and palpation methods in identifying the cricothyroid membrane (CTM), and compare the results with the gold standard method-computed tomography (CT) scan. METHODS A total of 110 patients were included into the study. The midline was estimated by a single investigator using both the US and palpation methods from the prominence of the thyroid cartilage to the center of the sternal notch, and the distance was measured (in millimeters) between the two points: Point A (the midpoint of CTM) and Point B (the inferior process of thyroid cartilage). Furthermore, the distance between Point A and Point B was calculated using the CT images. Time taken to assess the CTM by using US and palpation methods were recorded. Moreover, difficulty in using the two methods was measured with the visual analog scale (VAS). In addition, demographic and morphometric characteristics of the patients were noted. RESULTS The CTM was detected accurately in 50 (45.5%) patients with palpation and 82 (74.5%) with US. In the Bland-Altman analysis, a better agreement was observed with US. The time to assess CTM was shorter with US than with palpation, p

Amac: Vitamin D ve cinko eksikliginin astim ile iliskili oldugu bildirilmektedir. Bu calismada astimli cocuklarin klinik bulgulari ile vitamin D ve cinko duzeyleri arasindaki iliskiyi arastirmayi istedik. Materyal ve Metot: Bu prospektif calismaya yaslari 5‐17 arasinda degisen 149 astimli ve 97 saglikli cocuk dahil edildi. Tum katilimcilarin serum 25 hidroksivitamin D (25(OH)D) ve cinko duzeyleri olculdu, diyet aliskanliklari, bir yildaki solunum yolu enfeksiyonu sikliklari, hastane basvurulari ve gunes isigina maruziyet sureleri sorgulandi. Bulgular: Astimli cocuklarin serum D vitamini ve cinko duzeyleri sirasiyla (7,7±5,29 ng/ml), (64±16,3 mcg/dl) saglikli cocuklardan (12,3±12,87 ng/ml), (69±26,2 mcg/dl) belirgin sekilde dusuk bulundu (p

Objective: Cathelicidin is an important antimicrobial peptide in the urinary tract. Cathelicidin expression is strongly stimulated by 1,25-dihydroxy vitamin D in epithelial cells, macrophages/monocytes, and neutrophils. Vitamin D and cathelicidin status in children with urinary tract infection (UTI) caused by Escherichia coli is unknown. To establish the relationship between serum vitamin D and urine cathelicidin levels in children with a UTI caused by Escherichia coli. Methods: Serum 25-hydroxy vitamin D and urine cathelicidin levels were measured in 36 patients with UTI (mean age 6.8±3.6 years, range: 0.25-12.6 years) and 38 controls (mean age 6.3±2.8 years, range: 0.42-13 years). Results: There were no significant differences in urine cathelicidin levels between the study and control groups (p>0.05). Eight (22.2%) patients in the study group and 21 (58.3%) children in the control group were found to have sufficient vitamin D (≥20 ng/mL). Patients with sufficient vitamin D had higher urine cathelicidin levels than the controls with sufficient vitamin D (respectively 262.5±41.1 vs. 168±31.6 ng/mL, p=0.001). There were no significant differences between the patients and controls with insufficient vitamin D (p>0.05). Conclusion: The children with vitamin D insufficiency may not be able to increase their urine cathelicidin level during UTI caused by Escherichia coli. There is a need of prospective studies in order to prove a beneficial effect of vitamin D supplementation for the restoration of cathelicidin stimulation and consequently for prevention of UTI recurrence.