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Objective: To determine the characteristics of patients, mortality-affecting factors and mortality rate in follow-up burn-injured patients in an intensive care setting at a burns treatment centre. Method: The retrospective study was conducted between May and November 2014 at Kocaeli Derince Training and Research Hospital Burn Treatment Centre, Kocaeli, Turkey, and comprised data from January 2008 to January 2013 of in-patients who had been treated at the intensive care unit. The therapy outcomes and the follow-up processes were evaluated. Data was analysed using SPSS 17. Results: Of the 381 patients, 105(27.6%) were females and 276(72.4%) were males. The overall mean age was 28.4±21.1 years. There were 52(13.6%) mortalities, while 329(86.4%) survived. The mean total body surface area was 18.3±12.9% in those who survived compared to 52±24.3% in those who died (p66 years (p

In vitro cell culture is a powerful tool to assess cellular processes and test therapeutic strategies. For skeletal muscle, the most common approaches involve either differentiating myogenic progenitor cells into immature myotubes or the short-term ex vivo culture of isolated individual muscle fibers. A key benefit of ex vivo culture over in vitro is the retention of the complex cellular architecture and contractile characteristics. Here, we detail an experimental protocol for the isolation of intact flexor digitorum brevis muscle fibers from mice and their subsequent ex vivo culture. In this protocol, muscle fibers are embedded in a fibrin-based and basement membrane matrix hydrogel to immobilize the fibers and maintain their contractile function. We then describe methods to assess the muscle fiber contractile function using an optics-based, high-throughput contractility system. The embedded muscle fibers are electrically stimulated to induce contractions, after which their functional properties, such as sarcomere shortening and contractile velocity, are assessed using optics-based quantification. Coupling muscle fiber culture with this system allows for high-throughput testing of the effects of pharmacological agents on contractile function and ex vivo studies of genetic muscle disorders. Finally, this protocol can also be adapted to study dynamic cellular processes in muscle fibers using live-cell microscopy.

This study explores the relation between biomass‐specific succinic acid (SA) production rate and specific growth rate of an engineered industrial strain of Saccharomyces cerevisiae, with the aim to investigate the extent to which growth and product formation can be uncoupled. Ammonium‐limited aerobic chemostat and retentostat cultures were grown at different specific growth rates under industrially relevant conditions, that is, at a culture pH of 3 and with sparging of a 1:1 CO2–air mixture. Biomass‐specific SA production rates decreased asymptotically with decreasing growth rate. At near‐zero growth rates, the engineered strain maintained a stable biomass‐specific SA production rate for over 500 h, with a SA yield on glucose of 0.61 mol mol−1. These results demonstrate that uncoupling of growth and SA production could indeed be achieved. A linear relation between the biomass‐specific SA production rate and glucose consumption rate indicated the coupling of SA production rate and the flux through primary metabolism. The low culture pH resulted in an increased death rate, which was lowest at near‐zero growth rates. Nevertheless, a significant amount of non‐viable biomass accumulated in the retentostat cultures, thus underlining the importance of improving low‐pH tolerance in further strain development for industrial SA production with S. cerevisiae., Uncoupling of growth and product formation in industrial fermentation processes will minimize the formation of biomass as a by‐product and maximize the yield of product on substrate. In this work we provide a proof of principle of prolonged succinic acid production in an engineered, high producing, industrial strain of Saccharomyces cerevisiae at near‐zero growth rates.

Background & Objectives: Hypothermia, described as temperature < 35°C, is a frequent condition encountered in patients operated under general anesthesia. It is associated with significant morbidity and mortality. We aimed to estimate its incidence and to investigate the conditions associated with hypothermia in pediatric patients. Methods: This prospective clinical study was carried out in the operating theatre of a tertiary care center between August 2015 and September 2015. A total of 108 pediatric patients who underwent various surgical procedures that lasted for more than 30 minutes were enrolled. Baseline demographic data, types of surgical procedures, duration of operations, preoperative and perioperative body temperatures were recorded. The incidence of hypothermia and its possible correlates were sought. Results: Our series consisted of 108 children (77 males, 71.3%; 31 females, 28.7%) with an average age of 6.08±5.09 years were included in the study. There was no case diagnosed with hypothermia in the preoperative, perioperative and postoperative periods. Patients in American Society of Anesthesiologists classification (ASA) three group had significantly higher preoperative body temperatures compared to those in ASA-1 and ASA-2 groups (p = 0.027). The postoperative body temperature in patients receiving intravenous fluid replacement was significantly lower (p=0.017). Conclusion: For pediatric patients scheduled for surgical interventions, we recommend close monitorization and follow-up of body temperature, implementation of preventive measures to avoid hypothermia and routine perioperative heating. Avoidance of hypothermia may prevent hazardous consequences of postoperative hypothermia. doi: https://doi.org/10.12669/pjms.36.4.456 How to cite this:Esen O, Yilmaz G, Aydin N. Perioperative hypothermia in pediatric patients operated in a tertiary care center: Incidence and correlates. Pak J Med Sci. 2020;36(4):793-798. doi: https://doi.org/10.12669/pjms.36.4.456 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

A 15-year-old female patient presented at the clinic with heart failure (HF). A 12-lead electrocardiogram showed a heart rate of 170 bpm; negative P waves in leads DII, DIII, aVF; and long RP tachycardia (LRPT). Echocardiography demonstrated a shortening fraction (SF) of 20%. An electrophysiology study during tachycardia revealed an atrial-His time of 52 milliseconds and a His-atrial interval of 295 milliseconds. During ventricular entrainment, the postpacing interval-tachycardia cycle length was measured at 225 milliseconds. There was a pseudo V-A-A-V response. These findings confirmed the diagnosis of atypical atrioventricular nodal re-entrant tachycardia (aAVNRT). Successful slow pathway cryoablation was performed with an 8-mm-tip cryocatheter. After 2 weeks, the SF was measured as 34%. During a 2-year follow-up period, no recurrence was observed. In conclusion, fast-slow aAVNRT should be a part of the differential diagnosis of incessant LRPT leading to HF. Cryoablation can be used successfully in cases of aAVNRT.

Background: The aim of our study was to demonstrate if there is any relation between the neutrophil-to-lymphocyte ratio (NLR) and mortality in severe burns Methods: The records of 366 patients who were admitted to Intensive Care Unit of Burn Center of Derince Training and Research Hospital between January 2012 and December 2015 were evaluated retrospectively. The cases who were hospitalized in service or did not require intensive care were not included in the study. The cases were divided into two groups: ex-group (Group 1) and discharge group (Group 2). In both groups demographic information such as age, gender, burn scores, neutrophil counts and lymphocyte counts during admission to the hospital were recorded. NLR is the ratio of absolute neutrophil count to the absolute lymphocyte count. Results: NLR was 10.94±7.63 in the exitus group and 5.5±5.56 in the discharged group. NLR was increased in mortality group and this value was statistically significant (p=0.00). Independent relationship between prognoses and NLR was shown with logistic regression analyses (Odds Ratio 0.895, 95% confidence interval 0.856-0.936, p=0.00). Conclusion: NLR has increased in mortality group. Our study showed that NLR is correlated with probability of mortality after severe burn injuries. Therefore, it can be used as a cheap, easily obtained and new mortality predictor in severe burns.

Objective: The present study aimed to compare the upper airway dimensions as well as hemodynamic and anesthetic features of propofol, ketamine, and ketofol in children undergoing magnetic resonance imaging (MRI) scanning. Material and Methods: This retrospective study was carried out on data derived from a total of 89 patients aged between 1-160 months who were allocated in 3 groups concerning the anesthetic agents administered during sedation for MRI. Group I received ketamine and propofol (ketofol), whereas Group II had propofol and, and Group III received ketamine in this procedure. Results: The cross-sectional area of the upper airway at the levels of the base of tongue, soft palate and epiglottis were higher in patients receiving ketofol, compared to those receiving propofol or ketamin (p

Cocukluk caginda kazayla meydana gelen ani olumlerin en onemli nedenlerinden biri de trakeobronsial yabanci cisim aspirasyonlaridir. Ulkemizde gida aspirasyonu diger yabanci cisim aspirasyonlarina gore daha fazla gorulmektedir. Yabanci cisim aspirasyonu hava yollarinin tikanmasi sonucu gelisen bir mekanik asfiksi turudur. 6 ay-3 yas arasi cocuklarda daha sik gorulur, yuksek morbidite ve mortaliteyle seyreder. Yabanci cisim aspirasyonlarinda hizli tani ve ardindan yapilan broskoskopi hayat kurtarici olabilmektedir. Ancak bronkoskopi tecrube gerektirmesi ve uygulama zorluguyla birlikte cesitli komplikasyon riski tasir. Olgumuzda yabanci cisim aspirasyonu gelisen on dort aylik kiz cocuguna acil bronkoskopi ve tup torakostomi yapildi ve sekelsiz olarak 7. gun taburcu edildi. Anahtar kelimeler: Yabanci cisim aspirasyonu, bronkoskopi, pnomotoraks

WOS: 000403589400009 PubMed ID: 28530776 BACKGROUND: The aim of this study was to determine the factors affecting mortality rate among patients with an electrical burn. METHODS: A total of 115 patients admitted to the emergency department and hospitalized in the Burn Treatment Center or Intensive Care Unit (ICU) due to the electrical burn, were included in the study. RESULTS: A total of 115 patients (4 female and 111 male) with a mean age of 32.88 +/- 12.87 years were included in the study. The mean hospitalization period was 25.03 coproduct 20.50 days, and the mean total body surface area burned (% TBSA) was 22.83 +/- 15.54%. Among those patients, 9 (8.5%) expired, and the remaining 106 were discharged after treatment. In a logistic regression analysis, TBSA > 20% (p= 0.02, OR: 11.7, CI: 1.38-99.16); ICU requirement (p= 0.005, OR: 1.28, CI: 1.08-1.58); erythrocyte transfusion requirement (p= 0.02, OR: 12.48, CI: 1.44-107.83); fresh frozen plasma (FFP) requirement (p= 0.03, OR: 10.23, CI: 1.18-88.17); albumin requirement (p= 0.02, OR: 12.60, CI: 1.44-109.85); admission serum albumin level < 3.5 mg/dl (p= 0.04, OR: 7.25, CI: 0.82-63.64); and admission hemoglobin level < 12 mg/dl (p= 0.01, OR: 8.29, CI: 1.57-43.61) were determined as risk factors for mortality in patients with electrical burns. CONCLUSION: In clinical practice, defining a mortality risk analyzer using these factors may be helpful in the management of patients with electrical burns. Additional, more comprehensive studies are required to define the risk factors for mortality and long-term morbidities in patients with electrical burns. AMAÇ: Bu çalışmanın amacı elektrik yanığı olan hastalarda mortalite oranlarına etki eden faktörleri belirlemektir. GEREÇ VE YÖNTEM: Elektrik yanığı nedeniyle Derince Eğitim ve Araştırma Hastanesi Acil Servisi’ne kabul edilip yanık tedavi merkezi veya yoğun bakıma (YB) yatırılan 115 hasta çalışmaya dahil edildi. BULGULAR: Ortalama yaşı 32.88±12.87 yıl olan toplam 115 hastanın (4 kadın, 111 erkek) çalışmaya alındı. Ortalama hastanede yatış süresi 25.03±20.50 gün ve yanan ortalama toplam vücut yüzey alanı (%TVYA) ise %22.83±15.54 idi. Bu hastaların 106’sı tedavi sonrası taburcu edilirken, dokuzu (%8.5) hayatını kaybetti. Lojistik regresyon analizinde, TVYA >%20 (p=0.02, odds ratio (OR): 11.7, confidence interval (CI): 1.38–99.16), YB gerekenler (p=0.005, OR: 1.28, CI: 1.08–1.58); eritrosit transferi gerekenler (p=0.02, OR: 12.48, CI: 1.44–107.83); Taze donmuş plazma (TDP) gereksinimi olanlar (p=0.03, OR 10.23, CI: 1.18–88.17); albümin gereksinimi olanlar (p=0.02, OR: 12.60, CI: 1.44–109.85); kabulde serum albümin seviyesi

UNLABELLED Ganglioneuroma are rare, benign neural tumor of sympathetic nervous system originating from neural crest sympathogonia. Pelvic ganglioneuromas may mimic ovarian masses. We present a patient operated with the diagnosis of ovarian tumor which had a pelvic gangliuoneuroma. CASE An eleven-year old female patient complaining of abdominal pain and a mass was seen at our hospital. On examination a 10×10 cm mass was palpable in the pelvis. Laboratory parameters were all normal and the tumor markers such as β-HCG, AFP, CEA, serum catecholamines were negative. Abdominal ultrasonography and computed tomography showed an 11×6×9 cm solid mass containing calcification. The preoperative diagnosis was an adnexal mass of ovary. The patient was operated under general anesthesia and we found a retroperitoneal mass attached to the spine at L5. The tumoral mass was completely excised. Histopathological examination of tumor was reported as ganglioneuroma. The patient was discharged on seventh day of hospitalization with no neurological deficit. Retroperitoneal ganglioneuromas are usually present with local mass a benign tumoral course. The preoperative diagnosis may be difficult in pelvic ganglioneuromas due to close similarity with the ovarian masses. The treatment of the ganglioneuroma is total surgical excision and histology provides a confirmatory diagnosis.

WOS: 000396527500009 PubMed ID: 28261771 BACKGROUND: The aim of the present study was to present characteristic features and risk factors of paint thinner burns in order to raise awareness and help prevent these injuries. METHODS: Records of patients admitted to the burn unit due to paint thinner burns were retrospectively reviewed, and patients with comprehensive data available were included in the study. Total of 48 patients (3 female and 45 male) with mean age of 27.79 +/- 11.49 years (range: 4-58 years) were included in the study. RESULTS: Mean total hospitalization period was 30.25 +/- 27.11 days (range: 3-110 days), and mean total burn surface area was 32.53 +/- 24.06% (range: 3.0-90.0%). In 31 cases (64.6%), intensive care unit admission was required. Among all 48 patients, 9 (18.8%) died in hospital and remaining 38 were discharged after treatment. Primary cause of death was septicemia (n = 7) or respiratory failure (n = 6). Inhalation injury was present in 12 of the patients, 6 of whom died (50%). Statistically significant differences were found between expired and discharged patients when compared for presence of inhalation injury (p = 0.01) and septicemia (p = 0.031). CONCLUSION: Ignition of paint thinner is an important cause of burn injuries that may result in very severe clinical picture. Patients require prompt and careful treatment. Clinicians should be aware that inhalation injury and sepsis are the 2 main factors affecting mortality rate in this group of patients. With increased awareness, preventive measures may be defined. Further studies are warranted to decrease mortality rate in this subgroup of burn patients. AMAÇ: Bu çalışmanın amacı tinere bağlı yanıkları önlemek için bu yanıkların karakteristik özelliklerini incelemek ve risk faktörlerine olan farkındalığı artırmaktır. GEREÇ VE YÖNTEM: Tiner yanığı nedeniyle yanık ünitesine kabul edilen hastalar geriye dönük olarak tarandı, hastaların klinik kayıtları kapsamlı bir şekilde incelendi. Ortalama yaşları 27.79±11.49 (dağılım, 16–58 yaş) olan toplam 48 hasta (3 kadın, 45 erkek) çalışmaya alındı. BULGULAR: Ortalama hastanede kalış süresi 30.25±27.11 (dağılım, 3–110) gündü, ortalama toplam yanık yüzey alanı %32.53±24.06 (dağılım, %3.0–90.0). Toplam 31 hastada yoğun bakım ünitesi ihtiyacı oldu. Tiner yanığı olan hastaların dokuzu kaybedildi (%18.8), geriye kalan 38 hasta tedavileri sonrasında taburcu edildi. Ana ölüm nedeni septisemi (n=7) ve respiratuvar yetersizlikti (n=6). Hastaların 12’sinde inhalasyon yanığı eşlik ediyordu, bunlardan altısı kaybedilmişti (%50). Septisemi (p=0.031) ve inhalasyon hasarı (p=0.01) varlığı açısından karşılaştırıldığında, kaybedilen veya taburcu edilen hastalar arasındaki farklar anlamlı idi. TARTIŞMA: Tinerle temas, hızlı ve dikkatli tedaviler gerektiren çok ciddi klinik tablolara neden olabilen önemli bir yanık nedenidir. Klinisyenlerin bunun bilincinde olmalı, bu hasta grubunda inhalasyon yanığı ve sepsisin mortalitenin iki önemli nedeni olduğunu bilmelidir. Artan bilinçle önleyici tedbirler tanımlanabilir. Bu hasta grubunda mortalitenin azaltılması için daha fazla çalışma yapılmasına ihtiyaç vardır.

Arteriovenous fistula is a preferred approach to obtain vascular access in chronic hemodialysis patients. Arteriovenous fistula has some effects on cardiac and pulmonary systems. High output heart failure is a rare but an important complication of arteriovenous fistula. We report here a case of acute pulmonary arteriovenous fistula in a hemodialysis edema after creating, Arteriovenöz fistül, kronik hemodiyaliz hastalarında damar eriĢimi için sıklıkla tercih edilen bir yoldur. Arteriovenöz fistülün kalp ve pulmoner vasküler sistem üzerinde etkileri mevcuttur. Yüksek debili kalp yetmezliği, arteriovenöz fistülün nadir görülen önemli bir komplikasyonudur. Burada, sol akciğeri malignite nedeni ile total olarak alınan ve arteriovenöz fistül açılmasını takiben akut akciğer ödemi geliĢen bir hemodiyaliz hastası sunulmuĢtur.Anahtar Kelimeler: akciğer ödemi, arteriovenöz fistül, hemodiyaliz, kalp yetmezliği, pnömonektomi

Aim: A repeatedly asked question is why, under the same working conditions, one individual burns out, whereas another shows no symptoms at all. We sought to address this among nurses, who are considered to be particularly susceptible to the danger of burnout due to the nature of their work. Methods: This study was carried out with 108 randomly selected nurses working at Derince Training and Research Hospital. The Maslach burnout inventory and temperament character inventory were applied. Results: Novelty seeking (NS) and harm avoidance (HA) scores showed a positive correlation with high burnout level; a negative correlation was shown with persistence (P), self-directedness (SD), and cooperation (C). According to the regression analysis performed in order to assess whether personality characteristics are predictive of burnout levels, Novelty Seeking and HA were positive predictors, while C was a negative predictor of total burnout levels. Conclusion: This study showed that there is a relationship between the temperament and character traits and burnout. While analyzing the structure of healthcare provider systems, individual specific evaluations and development of personality traits that are protective against individual burnout should be put on the agenda.

Giris: Bu calismada, hastane icinde aktive edilen mavi kod sonrasi uygulanan kardiyopulmoner resusitasyon ve Acil servislerde uygulanan kardiyopulmoner resusitasyon karsilastirarak, mavi kod uygulamasindaki yeterlilik durumunu degerlendirmeyi amacladik. Gerec ve Yontem: 1 Ocak 2011 ile 30 Nisan 2013 tarihleri arasinda retrospektif olarak yapilan calismamizda, mavi kod verilen ve Acil serviste arrest gelisen hastalarin yas, cinsiyet, kardiyopulmoner resusitasyon suresi, sonucu ve kardiyopulmoner resusitasyonda kullanilan ilaclar degerlendirildi. Ayrica mavi kod verilen hastalarin bulundugu servis veya unite, mavi kod ekibinin olay yerine ulasma suresi ve mavi kod ekip lideri olan hekimin uzmanlik bransi kaydedildi. Bulgular: Calismamiza mavi kod cagrisi yapilan 250 arrest olgusu ve Acil serviste mudahale edilen 331 arrest olgusu incelendi. Acil serviste arrest gelisen hastalar, mavi kod verilen hastalardan daha genc olup ( p 0.05). Hastaya ulasma zamani ve kardiyopulmoner resusitasyon yapma suresi daha kisa, kardiyopulmoner resusitasyona yanit alma orani daha yuksekti ( p

Aim: The use of central venous access devices and especially venous port catheters is increasing day by day due to frequent venous Interventions and long-term and painful treatment in chemotherapy treatment of cancer patients. In this study, we aimed to evaluate the applications of chemotherapy port-catheters in pediatric patients. Material and Methods: Between 2014 and 2017, 76 pediatric cancer patients who were inserted venous port catheters for chemotherapy treatment in our hospital were evaluated retrospectively. Demographic data, diagnoses, port implantation site, and complications observed during and after the procedure were examined. The ports were placed under general anesthesia. Fluoroscopy was used during port placement, but not ultrasound. Results: The mean age of the patients was 6.88 +/- 4.79 (1-16) years and consisted of 31 (40.8%) female and 45 (59.2%) male patients. A chemotherapy portcatheter was inserted through the right subclavian vein in 48 patients, the left subclavian vein in 27 patients, and the right internal jugular win in 1 patient Five French (n=46; 60.5%), 6Fr (n=18; 23.7%) and 7Fr (n-12; 15.8%) port catheters were used for the number of patients involved. Arterial puncture was seen in 17 patients. Infection developed in 12 patients who received antibiotic therapy. Resorbed pneumothorax developed in one (1.3%) patient. No malposition was observed during the procedure. Discussion: Despite some complications that may occur during chemotherapy port-catheter implantation in patients who will receive chemotherapy, it is a preferred method in terms of patient comfort. It is recommended to use imaging methods during and after the procedure to reduce complications.