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Objectives: The pandemic of coronavirus disease 2019 (COVID-19) seriously affected psychological, economic, and social aspects of life. We aimed to compare the clinical characteristics of children with new-onset type 1 diabetes mellitus diagnosed in the lockdown period with the profile of those diagnosed before the pandemic. Material and Methods: The clinical features of 39 patients with new-onset type 1 diabetes diagnosed within 1 year starting from March 16, 2020, when schools were closed due to the COVID-19 pandemic in our country, were compared with the features of 27 patients with new-onset type 1 diabetes diagnosed in the previous year. Results: Twenty-three (58.9%) of 39 patients presented with DKA in the pandemic group, while 7 (25.9%) of 27 patients presented with DKA in the pre-pandemic group (P = 0.008). A significant increase was also noted in the severe presentation in the pandemic group (P = 0,019). The decrease in HbA1C at the end of 3 months was significantly higher in the pandemic group. Conclusion: Evaluation of patients with new-onset type 1 diabetes before and after pandemic showed a significant increase in the rates of severe DKA.

Background Intraoperative supplemental oxygen may reduce postoperative nausea and vomiting by mitigating hypoxic stress on the gastrointestinal tract. The authors therefore tested the hypothesis that supplemental oxygen reduces nausea and vomiting in adults recovering from colorectal surgery at the Cleveland Clinic between January 28, 2013, and March 11, 2016. Methods Initially, the authors conducted an unplanned subanalysis of a previous trial that evaluated the effect of 80% versus 30% intraoperative inspired oxygen on surgical site infection. Specifically, they assessed the effect of 80% versus 30% oxygen concentration on the incidence of postoperative nausea and/or vomiting. Thereafter, the authors conducted a systematic review and meta-analysis of the effect of supplemental oxygen on postoperative nausea and vomiting. Results The authors’ underlying analysis included 5,057 colorectal surgeries on 4,001 patients. For 2,554 surgeries, assignment was to 80% oxygen, and in 2,503 surgeries, to 30%. Postoperative nausea and vomiting was 852 of 2,554 (33%) in 80% oxygen and 814 of 2,503 (33%) in 30% oxygen. The estimated relative risk (95% CI) of 80% versus 30% oxygen on postoperative nausea and vomiting was 1.04 (0.96 to 1.12) in a generalized estimating equation model adjusting for within-patient correlation for patients with multiple surgeries, P = 0.355. Furthermore, supplemental oxygen did not reduce antiemetic use (P = 0.911) or the severity of nausea and vomiting (P = 0.924). The authors’ meta-analysis included 10 qualifying trials (6,749 patients) and did not find a difference in postoperative nausea and vomiting: relative risk, 0.97 [95% CI, 0.86 to 1.08], P = 0.55, I2 = 52%. Conclusions The incidence of postoperative nausea and vomiting did not differ in patients assigned to 80% or 30% inspired oxygen. A meta-analysis of available trials similarly indicated that supplemental intraoperative oxygen does not reduce postoperative nausea and vomiting. Therefore, supplemental oxygen should not be given in the expectation that it will reduce nausea and vomiting. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

Chest pain is relatively common postoperatively. Myocardial infarction (MI) is one cause of chest pain after surgery, but chest pain also results from less severe conditions. Because of its potential severity, chest pain usually prompts the activation of Rapid Response Systems (RRS). While chest pain is a cardinal symptom of myocardial ischemia in the non-surgical setting, the significance and relevance of chest pain after noncardiac surgery remains unclear.We conducted a retrospective analysis of noncardiac surgical inpatients for whom postoperative chest pain triggered our multidisciplinary RRS.Surgical wards at Cleveland Clinic, Cleveland, OH.Postsurgical patients after noncardiac surgery in whom the RSS system was activated for chest pain.RRS specified interventions like ECG readings, troponin measurements, transfer to ICU.Our primary outcome was MI. Secondary outcomes included the proportion of patients who had an ECG performed, troponin measurements, echocardiography, cardiac catheterization, and were admitted to the Intensive Care Unit (ICU).5850 surgical patients experienced postoperative chest pain and triggered an RRS activation between 2009 and 2019. A total of 3110 patients had troponin T measured within 6 h after RRS activation, and 538 of them (17%) had elevated troponin, meeting the Fourth Universal Definition criteria for MI. Additionally, 2 patients had ST-segment elevation infarction (STEMI) without troponin measurement. Among the 540 patients with MI, only 19 (3.5%) were diagnosed with a STEMI by ECG, 388 (72%) had echocardiography, 43 patients (8%) had cardiac catheterization, 8 patients (1.5%) required emergent cardiac surgery, and 424 (79%) were admitted to an ICU.Chest pain is a serious clinical sign, often indicating a postoperative myocardial infarction, and therefore should be taken seriously. Troponin screening should be routinely considered in postsurgical patients who report chest pain.

INTRODUCTION Postoperative pain is a distressful experience and remains to be a significant concern after surgery. Current agents either fail to prevent or minimize postoperative pain or cause a series of adverse effects, addiction, or abuse. Opioids have been the gold standard in the treatment of postoperative pain despite their well-described adverse effects. Many new agents with different mechanisms of action have been recently introduced to address this issue. AREAS COVERED This current review summarizes the list of new and emerging drugs investigated for their efficacy in controlling the postoperative pain and decreasing the need for rescue opioid use, adverse effect profile, abuse, and addiction potential. EXPERT OPINION Opioids have unrivaled analgesic efficacy. However adverse effects of opioids led to the search for better options. In mild pain most of the emerging drugs have been shown to control postoperative pain and decrease the use of rescue opioid, however fail to control pain after major surgeries causing severe pain. Specific agents such as Oliceridine, new local anesthetics, etc., are effective in controlling severe pain and hold a promise to replace opioids in the near future.

Laron syndrome (LS) is a rare disorder leading to short stature as a result of growth hormone (GH) insensitivity. It is caused by mutations in GH receptor gene and characterized by post-natal growth retardation, craniofacial abnormalities, high serum GH and low insulin-like growth factor-I (IGF-I) levels. Several different genetic mutations have been documented up to date. In this article, a patient with LS is reported. A 2-year-old female patient was admitted to the hospital with the complaint of short stature. Her height and weight was 71.7 cm [

Pseudohypoparathyroidism (PHP) is a heterogeneous group of disorder with parathormone target organ resistance, characterized by hypocalcemia, hyperphosphatemia and high blood parathormone (PTH). Typical phenotypic symptoms and additional hormonal resistance can be observed in type Ia, which is also known as Albright hereditary osteodystrophy. Our patient was an eight-year and nine-month old girl with typical Albright-s hereditary osteodystrophy phenotype including short stature, obesity, round face, low nasal bridge, shortened metacarpals, and mild mental retardation. In her biochemical examination, high PTH level and hypothyroidism is detected in spite of normal calcium and phosphor levels. As a result of clinic and laboratory tests, the findings were consistent with PHP type Ia with normocalcemia. In her guanine nucleotide binding protein (G protein), alpha stimulating activity polypeptide 1 (GNAS 1) gene serial analysis, C-308T>C (p1103T) transformation was detected, which was previously reported in a PHP type Ia patient. In this report, we-ve aimed to emphasize the fact that calcium and phosphor level in the blood of the patient with PHP type Ia can be measured normal.

To measure the possible association between subhypnotic propofol infusion during general balanced anesthesia and the incidence of PONV.Retrospective Cohort Analysis Using Propensity Score Matching.Postanesthesia care unit and inpatient unit.Patients with American Society of Anesthesiologists (ASA) physical status I-IV, undergoing non-cardiac surgery lasting2 h were included. Patients were excluded if transferred to the intensive care unit after surgery or received ketamine. Initially 70,976 patients were screened, and a cohort of 51,707 eligible adult patients undergoing non-cardiac surgery under general balanced anesthesia between 2015 and 2019 were included. Using a propensity score matching, 3185 patients who received subhypnotic propofol during general balanced anesthesia were matched with 5826 patients who did not receive subhypnotic propofol in a 1:2 ratio.None.The primary outcome was the incidence of PONV during PACU stay. The secondary outcome was the incidence of PONV within the first 24 h after surgery. Exploratory outcomes were time-to-extubation and length of hospital stay.A total of 9011 patients were included (3185 patients who received propofol infusion, and 5826 patients who did not receive propofol infusion) after propensity score matching. The adjusted odds ratio for PONV incidence was 1.03 (95% CI: 0.90, 1.18; p = 0.635) in PACU, and 1.05 (95% CI: 0.90, 1.23; P = 0.50) within 24 h after surgery. The length of hospital stay was 6 h shorter (ratio of means (95% CI) of 0.92, 0.89, 0.94), p 0.001) and time-to-extubation was 2 min longer (ratio of means 1.24 (1.20, 1.28), p 0.001) in patients receiving subhypnotic propofol infusion.Our study suggests that subhypnotic propofol infusion during general balanced anesthesia is not associated with a reduction in the incidence of PONV during PACU stay and within the first 24 h after surgery. However, it is associated with decreased LOS and increased time-to-extubation, but differences in neither outcome were clinically important.

To describe the prevalence of various circadian blood pressure patterns in adults recovering from abdominal surgery, and to evaluate the association between loss of normal circadian variation in blood pressure and hypotension during the initial 2 postoperative days.A post-hoc analysis of data obtained from two randomized trials.Operating rooms of the Cleveland Clinic.Adults having abdominal surgery from 2015 to 2019 with at least one overnight stay. Participants were continuously monitored by wearable vital signs monitors starting in the post-anesthesia care unit and for the first 48 postoperative hours.None. The exposure of interest was the degree of nocturnal decrease in blood pressure - normal nocturnal decrease in blood pressure ("normal dipping", more than 10% decrease compared to day-time), no nocturnal decrease ("non-dipping", less than 10% nocturnal decrease), or nocturnal increase in blood pressure ("rising").Postoperative hypotension, defined by the time weighted average (TWA) area under a mean arterial pressure (MAP) threshold of 70 mmHg.In total, 590 patients were eligible for analysis (mean(SD) age 50(15) years, 56% females, median [IQR] surgery duration 4.0 [2.7, 5.8] hours). Median TWA area under a MAP threshold of 70 mmHg was 0.96 (95%CI 0.59, 1.33) mmHg*minute per monitoring hour lower in patients with either no nocturnal blood pressure decrease (N = 317, 54%), or an increase in nocturnal blood pressure (N = 211, 36%), than in the reference group of patients with normal nocturnal decrease (N = 62, 11%), P 0.001 for both.Abnormal diurnal blood pressure patterns are common in adults during the initial 2 days after abdominal surgery. Lack of normal night-time decrease in blood pressure is associated with less postoperative hypotension. Future studies should evaluate whether abnormal postoperative diurnal blood pressure patterns are associated with worse outcomes.

Purpose: Drought will be one of the most important questions in the future. The easiest and natural way to drought recovery is to popularize the use of materials that will increase the water holding capacity of soils. The aim of this study is to determine the effect of hazelnut husk applying in water stress conditions on stomatal traits and the growth of maize.Materials and Methods: A greenhouse experiment was conducted in a randomized plot design using three factors:hazelnut husk doses (30-60-80 t ha-1) and three water stress levels (at 75%, 50% and 25% of field capacity); and two different soil texture (clay loam and sandy loam) with three replications.Results: Root fresh weight, total biomass and root:shoot ratio increased by 73%, 51% and 39% respectively when plants grown in clay loam soil are compared with sandy loam soil. Hazelnut husk applications affected both plant growth and stomatal traits, the most effective dose was 80 t ha-1 but the dose of 60 t ha-1 was found sufficient for the stomatal traits. Water stress caused a significant decrease in shoot growth (16-52%), leaf area (13-44%) and stomatal traits whereas irrigation at 50% of field capacity with 60 t ha-1 of the husk was found sufficient.Conclusion: It is thought that other morphological features are also not affected because hazelnut husk prevents the roots from being affected by stress. However, further studies are needed to determine the effects under field conditions.

Aim The exact mechanisms that trigger the onset of puberty are not well known. Adipomyokines are postulated to stimulate the central neural network. In the present study, we investigated irisin levels in girls with central precocious puberty (CPP), slowly progressing precocious puberty (SPPP), or premature thelarche (PT); we also studied prepubertal girls and to determine if this adipomyokine could be used as a marker in this context. Methods A total of 94 girls including 33 with CPP, 31 with precocious puberty (PP) variants (SPPP or PT), and 30 healthy controls were enrolled to the study. The mean irisin levels were compared between groups. The bivariate correlations of irisin levels with clinical and laboratory parameters were assessed. Multivariate linear regression analysis was performed to determine independent predictive factors of irisin levels. Results Irisin levels were higher in the CPP group compared with the other groups (CPP group: 723.25 ± 62.35 ng/mL; PP variants group: 529.60 ± 39.66 ng/mL; and control group: 325.03 ± 27.53 ng/mL) (P Conclusions The mean irisin levels were higher in patients with CPP compared with other groups. The results of this study imply that increased irisin levels may be used as a marker of CPP provided that these findings are confirmed in larger prospective studies.

Background Infraclavicular brachial plexus nerve block is a commonly performed anesthesiology technique in the upper extremity. Local anesthetics may be administered at different temperatures for both neuraxial and peripheral nerve blocks. We aimed to evaluate the effects of the temperature of the local anesthetic at the time of administration on the onset and duration of sensory and motor blocks in infraclavicular brachial plexus nerve block. Methods A total of 80 patients undergoing elective upper extremity surgery were randomly assigned to one of the following groups using a computer-based randomization software; low temperature (4 °C) (Group L, n = 26), room temperature (25 °C) (Group R, n = 27) and warmed (37 °C) (Group W, n = 27). A 1:1 mixture of 2% lidocaine and 0.5% bupivacaine was used as local anesthetic. Infraclavicular brachial plexus nerve block was performed under ultrasound guidance in all patients preoperatively. The onset and duration of sensory and motor blocks were recorded. Results Each group had different onset of motor (p< 0.001) and sensory (p< 0.001) blocks. The duration of motor block was similar between groups (p= 221). However, a significant difference was found in the duration of sensory block between group L (399.1 ± 40.8 min) and group R (379.6 ± 27.6 min) (p= 0.043). There was no complication related to nerve block procedure. Conclusions The administration of the local anesthetic at lower temperatures may prolong the onset of both motor and sensory blocks in infraclavicular brachial plexus nerve block.

Background Cytochrome P450 Oxidoreductase (POR) deficiency is one of the rare forms of adrenal insufficiency. It causes suspicious genitalia in boys. The disorder in steroid synthesis carries the symptoms of both 21-hydroxylase and 17–20-lyase deficiency. Cortisol deficiency is not frequent, but the stress response is impaired. Case An 8-month-old male patient was admitted to our hospital with vomiting for 15 days. Hyponatremia and hyperkalemia were detected in the first laboratory tests of the patient and he was hospitalized for further investigation. In the background: The patient was born at term by caesarean section. His birth weight was 3600 grams, developmental stages were normal and he had no hospitalization before. Family history; the parents were healthy and they were unrelated. Physical examination; Height: 65 cm (-2,23 SDS; Results The patient is considered to have POR deficiency and his genetic research is in progress. Hydrocortisone 15 mg/m2/day and fludrocortisone 0.1 mg/day were prescribed. We presented this case for discussing POR deficiency as a cause of rare adrenal insufficiency.

Background Adipokines have been suggested to play an important role in the pathogenesis of polycystic ovarian syndrome (PCOS). Omentin is an adipokine secreted essentially by visceral adipose tissue with an insulin-sensitizing effect. Insulin resistance (IR) is a common feature of PCOS, therefore the aim of this study was to investigate omentin-1 level in adolescent girls with PCOS and its relationship with IR and androgens. Method A total of 41 obese girls with PCOS, and 30 age- and body mass index (BMI)-matched obese girls without PCOS were enrolled in the study. The demographic, clinic and laboratory characteristics of the groups were compared. Additionally, bivariate correlation analysis of omentin-1 with BMI standard deviation score (BMI-SDS), insulin, glucose, homeostatic model assessment of IR (HOMA-IR), total and free testosterone was performed. Results In the PCOS group HOMA-IR, free and total testosterone were higher than in the control group. Omentin-1 was lower in the PCOS group compared with the controls (55.01 ± 7.99 ng/mL vs 59.10 ± 7.02 ng/mL, respectively; P = 0.027). Omentin-1 was inversely correlated with free testosterone (r = -0.527, P = 0.030) and BMI-SDS (r = -0.241, P = 0.046) but it was not correlated with total testosterone, HOMA-IR, glucose, insulin or serum lipids. Conclusion Omentin-1 was lower in obese girls with PCOS and hyperandrogenism was associated with this condition.

Objective To investigate the relationship between brain masculinization and retinal thickness in children with congenital adrenal hyperplasia (CAH). Methods Forty-five patients with CAH aged between 4 and 18 years and 30 age-matched healthy controls were included in this prospective study. Macular area was examined with optical coherence tomography (OCT); central subfield thickness (CST), cube volume (CV) and macular retinal thickness (MT) were measured in each subject. A gender identity questionnaire (GIQ) was used for the evaluation of gender happiness index. Results Girls with CAH had a higher CV (p = 0.002) and MT (p = 0.003) than healthy girls. No significant difference was found between boys with CAH and healthy boys regarding the retinal thickness measurements. Mean CST, CV and MT were significantly higher in boys than in girls in the control group (p = 0.013, p Conclusions As retina is part of the brain, our finding appears to be a morphological evidence of the excess androgen exposure on brain structures in girls with CAH. In addition, we suggest using retinal thickness measurements as a marker of prenatal excess androgen exposure in future studies.

Objective: Androgen exposure is hypothesized to play a role in the development of autism spectrum disorder (ASD), attention deficit hyperactivity disorder (ADHD), and disruptive behavior disorders/DBDs (oppositional defiant disorder/ODD and conduct disorder/CD). The aim of this cross-sectional study was to investigate ASD, ADHD, and DBD (ODD and CD) traits in children and adolescents with congenital adrenal hyperplasia (CAH), a natural cause of prenatal androgen excess in females. Methods: Forty-five children and adolescents (27 girls, mean age 11.1±3; 18 boys, mean age 10.8±3.6) with CAH and their unaffected siblings (16 girls, mean age 11.4±3.9; 14 boys, mean age 12.6±4.2) were included in the study. Parents completed the Social Communication Questionnaire, to measure ASD symptoms; and the Turgay DSM-IV-Based Child and Adolescent Disruptive Behavioral Disorders Screening and Rating Scale to assess ADHD and DBD traits. Results: In this study, boys but not girls with CAH showed higher autistic traits. There was no significant difference between either girls or boys with CAH and their unaffected counterparts with respect to inattention or hyperactivity symptoms. Boys with CAH showed more ODD symptoms than the unaffected boys. There was a trend for boys to have more CD symptoms compared to unaffected boys. Conclusions: Our study does not support the hypothesis that prenatal androgen exposure is associated with ASD, ADHD or DBDs. Postnatal/circulating androgen levels, higher testosterone/cortisol ratio, lower basal cortisol or dysregulation in HPA axis might be related to higher autistic traits or increased DBDs symptoms found in boys with CAH. Further investigations with larger groups are needed to clarify these associations.

Amaç: Bu çalışmada; çok yıllık meteorolojik veriler mevcut olmadığında, daha önce meteoroloji istasyonu olmayan bir yere yeni bir istasyon kurulduğunda ya da ivedi olarak günlük buharlaşma verisi gerektiğinde buharlaşma modellerinin günlük iklim verileri kullanılarak gerçekleştirilen tahminleme süreçleri iki yıllık bir zaman periyodunda araştırılmıştır. Materyal ve Metot: Buharlaşma miktarını veren Penman (1948) ve Priestley-Taylor (PT) (1972) olarak seçilen iki model kullanılmıştır. A sınıfı buharlaşma kabı (Epan)’ ndan oluşan buharlaşma miktarını tahmin eden bu modeller Samsun’ un nemli iklim koşulları altında 2012 ve 2013 yıllarında sınanmıştır. Çalışmanın yapıldığı 2012 ve 2013 yılları iklim özellikleri, çok yıllık ortalamadan farklı ve aşırı yağışlı geçmiştir. Regresyon testi (R2), ortalama karekök hatası (RMSE), ortalamadan sapma (AD), ortalama nispi yüzde hatası (ARPE), yeterlilik katsayısı (CE) olarak verilen istatistiksel değerlendirme yöntemleri istasyonda ölçülen ve modeller yardımıyla tahmin edilen Epan değerlerinin başarısını belirlemek için kullanılmıştır. Modellerden elde edilen Epan değerlerinin performansı günlük ve aylık (günlük toplamlar kullanılarak) olarak değerlendirilmiştir. Ayrıca istasyonda Epan’ nın kurulu olduğu aylar (nisan-ekim ayları) istasyonda ölçülen ve tahmin edilen tüm Epan değerleri dikkate alınarak da bir değerlendirme yapılmıştır. Bulgular: Hem Penman hem de PT modellerinin sonuçları iyi bir Epan tahmini sağlamıştır. Bununla birlikte Penman modeli ile daha iyi istatistiki sonuçlar elde edilmiştir. Çalışmanın yapıldığı 2012 ve 2013 yıllarında Penman modeliyle sırasıyla günlük R2 değerleri 0.52 ve 0.70 ve aylık R2 değerleri ise 0.98 ve 0.96 olarak elde edilmiştir. Sonuç: Samsun ili gibi nemli iklime sahip yerlerde baraj, göl ya da herhangi bir su kütlesinden buharlaşma miktarı tahmin edilmek isteniyorsa Penman modelinin kullanılması tavsiye edilmektedir. Objective: This study researched for two years; how evaporation models with daily climate data will predict when weather station is new installed somewhere that does not have a weather station previously, when there is no meteorological data for many years or when daily immediately evaporation data are needed. Material and Methods: Two models chosen as Penman (1948) and Priestley-Taylor (PT) (1972), which give the amount of evaporation, were used for this study. These models estimated the amount of evaporation from the A class evaporation pan (Epan) were tried under the humid climate conditions of Samsun in years 2012 and 2013. In terms of climatic characteristics, 2012 and 2013 were different from long time periods annual averages and extremely rainy. Statistical methods given as regression test (R2), root mean square error (RMSE), average deviation (AD), average relative percentage error (ARPE), coefficient of efficiency (CE) were used to find out the success of Epan values measured in the station and predicted by models. The performance of Epan values of the models were evaluated daily and monthly (by using daily totals). Epan in the weather station installed for six months (from April – to October). During this time, total Epan values measured in the station and total predicted by models were compared. Results: The results of both Penman and PT models gave the good Epan prediction. In addition, Penman models gave the very good statistical results. 2012 and 2013 Penman model gave the daily values of 0.52 and 0.70 R2, the monthly values of 0.98 and 0.96 R2 respectively. Conclusion: Finally, use of Penman model for evaporation estimate from dam, lake or any water mass is recommended in places with a humid climate such as Samsun.