Sedoanalgesia Administration with Propofol and Ketamine for Minor Urologic Interventions

Aim: In this study we aimed to administer sedoanalgesia with propofol and ketamine combination in patients undergoing planned minor urologic interventions with limited anesthesia. By combining these two medications, lower doses may be used, and we aimed to provide sufficient sedation, analgesia and amnesia without disrupting hemodynamic and respiratory stability and to increase patient and surgeon satisfaction. Material-Method: The study included 53 patients with planned minor urologic interventions aged from 19 to 85 years and physical situation ASA I-III. After six hours starvation, patients were taken to the surgery. Patients were monitored for electrocardiography (ECG), oxygen saturation (SPO2 ) and non-invasive blood pressure. For use if necessary a nasal O2 cannula was inserted. A vein in the back of the left hand was opened and 5 ml/min isotonic sodium chloride infusion was begun. Patient heart rate (HR), systolic arterial pressure (SAP), diastolic arterial pressure (DAP), mean arterial pressure (MAP) and oxygen saturation (SpO2 ) values were measured and a 5 point sedation scale (Table 1) was used to measure sedation scores. Basal values were recorded (0 min). Later patients were randomly divided into two groups with Group I administered intraurethral lidocaine gel for local anesthesia by the surgeon, while Group II were administered intravenous 0.015 mg/kg midazolam, 0.5 mg/kg 1% ketamine and 0.5 mg/kg 1% propofol by the authors for sedoanalgesia. At five minute intervals the HR, SAP, DAP, MAP, SpO2 values and sedation scores were measured and recorded. Results: Statistical evaluation found a statistically significant increase in SAP, DAP and MAP values measured at the 5th minute in Group I patients compared to preoperative values. In Group I patients, when the heart rate measured in the 1st and 5th minutes are compared with preoperative values there was a statistically significant increase identified. In Group II patients, there was a statistically significant fall in SpO2 values in the 1st and 5th minutes compared with preoperative values. When patient and surgeon satisfaction are compared with Group I, Group II was found to be statistically significantly higher. Though the blood pressure and heart rate increases in Group I patients were statistically significant, they were not at levels that required clinical intervention and/or treatment. Similarly the SpO2 decrease observed in Group II patients did not fall below 90% in any patient in spite of being statistically significant and rose again without clinical intervention and/or treatment. Conclusion: In this study we showed that sedoanalgesia administration with propofol and ketamine may be an alternative method for patients undergoing minor urology interventions that does not disrupt hemodynamic and respiratory stability, does not delay patient discharge, has low side effect incidence and has high patient and surgeon satisfaction

Corneal melting after collagen cross-linking for keratoconus: a case report

<p>Abstract</p> <p>Introduction</p> <p>Corneal collagen cross-linking is a rather new technique that uses riboflavin and ultraviolet A light for collagen fiber stabilization in keratoconus corneas. Other than reversible side effects, the preliminary results of corneal collagen cross-linking studies suggest that it is a rather safe technique. In this report, we demonstrate a case of corneal melting after corneal collagen cross-linking for keratoconus corneas associated with an acute inflammatory response.</p> <p>Case presentation</p> <p>A 23-year-old Caucasian man with keratoconus cornea stage 1 to 2 underwent uneventful corneal collagen cross-linking treatment according to the Dresden protocol. The next day the patient had intense photophobia, watering and redness of the eye, and his visual acuity was limited to counting fingers. Slit lamp biomicroscopy revealed severe corneal haze accompanied by non-specific endothelial precipitates following an acute inflammatory response. Mild inflammation could be detected in the anterior chamber. Moreover, the re-epithelialization process could barely be detected. His corneal state gradually deteriorated, resulting in descemetocele and finally perforation.</p> <p>Conclusion</p> <p>In this report, we present a case of a patient with corneal melting after standard corneal collagen cross-linking treatment for keratoconus corneas following an acute inflammatory response. Despite modifying postoperative treatment, elaboration of all apparent associated causes by the treating physicians and undergoing extensive laboratory testing, the patient developed descemetocele, which led to perforation. Our report suggests that further research is necessary regarding the safety of corneal collagen cross-linking in keratoconus corneas.</p

Determination of the changes in the process of degradation of some pesticides applied in mixtures with plant growth regulators, foliar fertilizers and spreader-stricker in a vineyard [Bagda bitki gelişim duzenleyicisi, yaprak gubresi ve yayici-yapiştiricilarla kariştirilarak uygulanan bazi pestisitlerin parcalanma surecindeki degişimlerin belirlenmesi]

The study conducted in 2015-2016 examined effects of plant growth regulators (PGR), foliar fertilizers (FF) and spreader-sticker (SS) on the process of degradation of pesticides. First physical then chromatographic analyses were conducted in laboratory to determine whether degradation occurred even in spray tanks. In order to determine if changes occurred during the process of decomposition of pesticides in mixtures under field conditions, two experiments were set up in Izmir during the shooting and fruiting of grapevines in 2016. In shooting period, a mixture of azoxystrobin, imidacloprid and metalaxyl was blended with PGR, FF and SS in double and triple combinations to create eight treatments applied to three replicates to determine the process of degradation of active ingredients on leaf samples collected at given intervals. In general, it was observed that degradation of azoxystrobin, imidacloprid and metalaxyl on leaves applied with PGR, FF and SS was slower and the residues did not drop below maximum residue limits even after the preharvest interval. During the fruiting period, a mixture of boscalid, chlorpyrifos ethyl and hexythiazox was applied in the same way as for the shooting period. All mixtures with PGR, FF and SS tended to increase degradation of boscalid, but had no effect on the degradation on chlorpyrifos ethyl and hexythiazox. © 2018 Entomological Society of Turkey.All Rights Reserved

A Batch Adsorber Design for Rhodium Adsorption on Gallic Acid Formaldehyde Resin

The adsorption of rhodium (III) ions onto gallic acid formaldehyde resin in a batch adsorber has been studied. Adsorption experiments were carried out by agitating 1 g resin particles with 1000 ml of Rh (III) ion solution of the initial concentrations from 16.54 to 88.80 mg/l (293K, 1M HCl). Using Langmuir isotherm, a single stage batch adsorber was designed for different adsorbent mass/treated effluent volume ratios. An initial rhodium concentration of 100 g/m³ is assumed and the required amount of resin particles to recover metal ion content by 75%-99% at various volumes of effluents. For a single-stage adsorption system, thus the adsorbent demonstrated recovery capacity. For example, 1 m³ of solution is to be treated; the required masses of gallic acid resol resin are 25 kg for 75% rhodium removal. In order to recover 90% of the rhodium (III) at various volumes of solution which having different metal concentrations, the required amount of gallic acid resin was calculated. For example, 1 m³ of solution is to be treated, the required amounts of resin particles to reduce the rhodium content by 90% increased from 75 to 76 kg with increase in the initial rhodium metal concentration from 0.1 to 100 g/m³. Through such a projection, a real single stage adsorption system can be designed

Are middle school mathematics teachers able to solve word problems without using variable?

Many people consider problem solving as a complex process in which variables such as x, y are used. Problems may not be solved by only using ‘variable.’ Problem solving can be rationalized and made easier using practical strategies. When especially the development of children at younger ages is considered, it is obvious that mathematics teachers should solve problems through concrete processes. In this context, middle school mathematics teachers' skills to solve word problems without using variables were examined in the current study. Through the case study method, this study was conducted with 60 middle school mathematics teachers who have different professional experiences in five provinces in Turkey. A test consisting of five open-ended word problems was used as the data collection tool. The content analysis technique was used to analyze the data. As a result of the analysis, it was seen that the most of the teachers used trial-and-error strategy or area model as the solution strategy. On the other hand, the teachers who solved the problems using variables such as x, a, n or symbols such as Δ, □, ○, * and who also felt into error by considering these solutions as without variable were also seen in the study. © 2017 Informa UK Limited, trading as Taylor & Francis Group

Eye patching as a treatment for amblyopia in children aged 10-16 years

PubMedID: 21647569Purpose To investigate the effects of full-time patching regimen on the treatment of amblyopia in children aged 10-16 years. Methods Forty-seven patients with a mean age of 12.09 ± 1.65 years were included in this study. All of the patients received eye patching for the entire day, 6 days a week, during the first 3 months. The patients who achieved visual acuity of 0.00 logMAR at the third month were provided with additional patching treatment (4-6 h/day). On the other hand, the patients who showed no change in their visual acuity or an increase of less than 0.00 logMAR at the third month had 3 more months of eye patching for the entire day, 6 days a week. Results Prior to treatment, the best mean visual acuity of the amblyopic eyes was 0.48 ± 0.25 (range 1.00-0.15) logMAR. After follow-up, the visual acuity of the amblyopic eyes was 0.20 ± 0.22 (range 1.00-0.00) logMAR. Thus, visual acuity in the amblyopic eyes improved by 0.2 log unit or more in 38 of 47 patients (81%). Conclusions The present results show that patching in older children with amblyopia improves visual acuity with no serious complications. The use of patching in children to improve amblyopia seems promising. © Japanese Ophthalmological Society 2011

Insulin resistance and serum leptin levels in men with obstructive sleep apnea syndrome [Obstrüktif uyku apne sendromu olan erkek hastalarda i·nsülin rezistansi ve serum leptin seviyeleri]

Aim: The aim of this study was to assess the insulin resistance and serum leptin levels in patients with obstructive sleep apnea syndrome (OSAS), and to compare body mass indexes (BMI) of OSAS patients with matched controls without OSAS. Method: Twenty eight patients having apnea-hypopnea index (AHI)?5 included in the study. Thirty two healthy subjects assumed as a control group. Venous blood was obtained in the fasting state for the measurement of glucose, insulin and leptin levels. Insulin resistance index was based on the homeostasis model assesment method (HOMA-IR). Result: There was no significant difference in the serum leptin levels (control group, 32.88±24.22 ng/ml, OSAS group, 24.93±25.84 ng/ml) and HOMA-IR (control group, 3.01±1.81, OSAS group, 2.58±1.21) between control group and OSAS patients. Insulin resistance and circulating plasma leptin concentrations in OSAS patients were independent of the AHI and were not different from the control group. Conclusion: We concluded that insulin resistance and plasma leptin concentrations are mostly associated with the degree of obesity and BMI. Those parameters seem not to be related with the AHI in OSAS patients

İlköğretim Birinci Sınıf Öğrencilerinin Teknoloji Kullanım Sıklığı ve Ebeveyn Görüşleri

Giriş: Teknolojide yaşanan hızlı gelişmeler, her alanda olduğu gibi eğitim alanında da kendini göstermiştir. Yapılan çalışmalarda, teknolojinin etkili ve amacına uygun olarak kullanıldığı takdirde çocuklar üzerinde olumlu, gereğinden fazla kullanıldığında ise pek çok olumsuz etki yarattığı ortaya çıkmıştır. Bu çalışma ise, ilköğretim birinci sınıf öğrencilerinin teknoloji kullanım sıklıklarını ve ebeveyn görüşlerini incelemek amacı ile yapılmıştır. Gereç- Yöntem: Tanımlayıcı nitelikteki bu çalışmanın evrenini (n:240) İstanbul ilinde bir ilkokulun tüm birinci sınıf öğrencilerinin ebeveynleri oluşturmuştur. Örneklemi ise araştırmaya katılmayı kabul eden 151 sayıda veliden oluşmuştur. Uzman görüşleri ile araştırmacılar tarafından hazırlanan üç bölümden oluşan bir ölçek kullanılmıştır. Araştırmada veri toplama aracı olarak kullanılan anket, Likert ölçeği şeklinde hazırlanmıştır. Bulgular: Araştırmaya katılan ebeveynlerin 100’ü (%66,2) telefon, 41’i (%27,2) tablet ile çocukların internete giriş yaptığını belirtmiştir. Katılımcıların %67,5’i bilgisayar ve internet bağlantısına sahip olduğunu ifade etmiştir. Ebeveynlerin internet hakkındaki kısaca düşünceleri incelendiğinde, katılımcıların 94’ü (%62,7) internet erişimi için olmalı cevabını vermişlerdir. Sonuç: Çocukların güvenli bir şekilde teknolojiyi kullanmaları adına en önemli denetleyicilerden biri olan ebeveynlerin bu konuda farkındalıklarını arttırmaya yönelik çalışmalara önem verilmelidir. Bu bağlamda devlet kurumları, belediyeler, aile sağlığı merkezleri, sivil toplum örgütleri tarafından özellikle bilgisayar-internet gibi teknoloji ürünlerinin çocukların sağlığı üzerindeki etkilerine karşı güvenli kullanım önerileri sunmak amacıyla eğitim faaliyetleri düzenlenebilir