Comparison between magnesium sulfate and dexmedetomidine in controlled hypotension during functional endoscopic sinus surgery

AbstractBackground and objectivesIt is crucial to decrease bleeding during functional endoscopic sinus surgery. Our primary goal was to investigate the effects of magnesium sulfate and dexmedetomidine used for controlled hypotension on the visibility of the surgical site.Methods60 patients aged between 18 and 65 years were enrolled. In the magnesium sulfate group (Group M), patients were administered 40mg/kg magnesium sulfate in 100mL saline solution over 10min as the intravenous loading dose 10min before induction, with a subsequent 10–15μg/kg/h infusion during surgery. In the dexmedetomidine group (Group D), patients were administered 1μg/kg dexmedetomidine in 100mL saline solution as the loading dose 10min before surgery and 0.5–1μg/kg/h dexmedetomidine during surgery. Deliberate hypotension was defined as a mean arterial pressure of 60–70mmHg.ResultsBleeding score was significantly decreased in Group D (p=0.002). Mean arterial pressure values were significantly decreased in Group D compared to that in Group M, except for the initial stage, after induction and 5min after intubation (p<0.05). The number of patients who required nitroglycerine was significantly lower in Group D (p=0.01) and surgeon satisfaction was significantly increased in the same group (p=0.001). Aldrete recovery score ≥9 duration was significantly shorter in Group D (p=0.001). There was no difference between the two groups in terms of recovery room verbal numerical rating scale.ConclusionsDexmedetomidine can provide more effective controlled hypotension and thus contribute to improved visibility of the surgical site

Worker deaths: A regional autopsy study

Amaç: Uluslararası Çalışma Örgütü’ne göre her 15 saniyede bir 153 işçi iş kazası geçirmekte ve bir işçi iş kazaları veya hastalıklar nedeniyle ölmektedir. Dünyada her gün 6.300 insan iş kazaları veya işle ilişkili hastalıklar nedeniyle ölmektedir. Yöntem: Adli Tıp Kurumu Trabzon Grup Başkanlığı Morg İhtisas Dairesi’nde, 2011-2015 yılları arasında otopsisi yapılan, ölüm nedeni iş kazasına bağlanan olguların adli tahkikat evrakları ve otopsi raporları geriye dönük olarak incelendi. Bulgular: Toplam 112 işçi ölümünden 111’inin (%99,1) erkek, 1’inin (%0,9) kadın olduğu tespit edildi. Yaşları 18 ile 64 yıl arasında değişmekteydi. Olguların iş kollarına göre dağılımı incelendiğinde 61 (%54,5) olgunun inşaat sektöründe ve 12 (%10,7) olgunun enerji sektöründe çalıştığı tespit edildi. İş kazalarının 34 (%30,4) olguda yüksekten düşme, 19 (%17) olguda elektrik çarpması nedeniyle gerçekleştiği belirlendi. Yapılan otopsilerde 44 (%39,3) olguda kafatası kemik kırıkları, 22 (%19,6) olguda göğüs kafesi kırıkları vardı. Histopatolojik incelemelerde, 13 (%11,6) olguda kalp-damar patolojileri ve 20 (%17,9) olguda akciğerlerde ödem ve kanama bulundu. Sonuç: Ulusal iş kazası istatistikleriyle de uyumlu olarak, bu çalışmanın sonuçlarına göre, ilk sırada inşaat sektörü bulunmaktadır. Ölüm nedeni olarak ise yüksekten düşmeye bağlı genel beden travmaları, elektrik çarpmaları ve iş makinesi kazaları öne çıkmaktadır.Objective: According to the International Labor Organization, 153 workers are injured and one worker dies because of occupational accidents or diseases every 15 seconds. Every day, 6,300 people die due to occupational accidents or work-related diseases in the world. Methods: Forensic investigation documents and autopsy reports of patients who were autopsied between 2011 and 2015 at the Forensic Medicine Department of Morgue Specialization in Trabzon Group Presidency and whose causes of death were related to occupational accidents were examined retrospectively. Results: It was determined that 111 (99.1%) were male and 1 (0.9%) were female from a total of 112 worker deaths. Their ages ranged between 18 and 64 years. When the distribution of cases by business types was analyzed, it was determined that 61 (54.5%) cases worked in the construction sector and 12 (10.7%) in the energy sector. It was determined that work accidents occurred due to falling from height in 34 (30.4%) cases and electric shock in 19 (17%) cases. There were skull bone fractures in 44 (39.3%) cases and rib cage fractures in 22 (19.6%) cases during autopsies. In histopathological examinations, there were cardiovascular pathologies in 13 (11.6%) cases, edema and bleeding in the lungs in 20 (17.9%) cases. Conclusion: According to the results of this study, construction sector took place on the top, which is consistent with the national work accident statistics. As a cause of death, general body traumas due to falling from high, electric shocks and work machine accidents come to the fore

Expert opinion on screening, diagnosis and management of diabetic peripheral neuropathy: a multidisciplinary approach

The proposed expert opinion aimed to address the current knowledge on conceptual, clinical, and therapeutic aspects of diabetic peripheral neuropathy (DPN) and to provide a guidance document to assist clinicians for the best practice in DPN care. The participating experts consider the suspicion of the disease by clinicians as a key factor in early recognition and diagnosis, emphasizing an improved awareness of the disease by the first-admission or referring physicians. The proposed “screening and diagnostic” algorithm involves the consideration of DPN in a patient with prediabetes or diabetes who presents with neuropathic symptoms and/or signs of neuropathy in the presence of DPN risk factors, with careful consideration of laboratory testing to rule out other causes of distal symmetric peripheral neuropathy and referral for a detailed neurological work-up for a confirmative test of either small or large nerve fiber dysfunction in atypical cases. Although, the first-line interventions for DPN are currently represented by optimized glycemic control (mainly for type 1 diabetes) and multifactorial intervention (mainly for type 2 diabetes), there is a need for individualized pathogenesis-directed treatment approaches for DPN. Alpha-lipoic acid (ALA) seems to be an important first-line pathogenesis-directed agent, given that it is a direct and indirect antioxidant that works with a strategy targeted directly against reactive oxygen species and indirectly in favor of endogenous antioxidant capacity for improving DPN conditions. There is still a gap in existing research in the field, necessitating well-designed, robust, multicenter clinical trials with sensitive endpoints and standardized protocols to facilitate the diagnosis of DPN via a simple and effective algorithm and to track progression of disease and treatment response. Identification of biomarkers/predictors that would allow an individualized approach from a potentially disease-modifying perspective may provide opportunities for novel treatments that would be efficacious in early stages of DPN, and may modify the natural course of the disease. This expert opinion document is expected to increase awareness among physicians about conceptual, clinical, and therapeutic aspects of DPN and to assist them in timely recognition of DPN and translating this information into their clinical practice for best practice in the management of patients with DPN