Subklavian Ven Port Kateteri Komplikasyonu: Bilateral Masif Pnömotoraks

Günümüzde venöz port kateter sistemleri kanser hastalarının uzun süreli kemoterapi tedavisinde aralıklı infüzyon için yaygın olarak kullanılmaktadır. Bu girişimsel işlemin uygulama yerine bağlı olarak enfeksiyon, hematom, kataterin kırılması, arter yaralanmaları, kateterin yer değiştirmesi, pnömotoraks, venöz tromboz gibi komplikasyonlar ortaya çıkmaktadır. Subklavian venöz port kateter işlemi diğer anatomik alanlara göre daha fazla tek taraflı pnömotoraks riski taşımaktadır. Mide malign neoplazm tanısı olan 37 yaşında kadın hasta acil servise üç gündür devam eden bilateral yan ağrısı ve dizüri şikayeti ile başvurdu. Dört gün önce bilateral subklavian venöz port girişim öyküsü olan hastada nefes darlığı ve oksijen satürasyon düşüklüğü saptanmadı. Burada atipik klinikle acil servise başvuran, insidental olarak tanı konan iyatrojenik bilateral masif pnömotoraks olgusunu sunmayı amaçladık

Mogu li parametri kompletne krvne slike predvidjeti duboku vensku trombozu?

The aim of this study was to evaluate complete blood cell count parameters including red blood cell indices, white blood cell subtypes, and platelet indices for predicting deep vein thrombosis (DVT). A total of 71 (44 male and 27 female) patients with acute femoral and popliteal DVT diagnosed by doppler ultrasonography during a period of seven years (2011-2017) were included in the study. By matching age and gender, 142 (88 male and 54 female) subjects diagnosed with venous insufficiency in the same time interval were assigned as control group. Data were obtained by reviewing hospital records of the study participants, including clinical and demographic characteristics and complete blood cell parameters. Frequencies of hypertension, diabetes mellitus, chronic obstructive pulmonary disease, chronic renal failure, and coronary arterial disease were higher in DVT group as compared to non-DVT group (p<0.05). Hemoglobin and lymphocyte values were lower, and red blood cell distribution width, neutrophil, neutrophil to lymphocyte ratio, and platelet to lymphocyte ratio higher in DVT group as compared with non-DVT group (p<0.05). There was no significant between-group difference in terms of mean corpuscular volume, platelet, mean platelet volume, mean platelet volume to platelet ratio, and platelet distribution width (p>0.05). Hypertension, hemoglobin, neutrophil to lymphocyte ratio, and platelet to lymphocyte ratio were independent risk factors for DVT. We found that hypertension, anemia, neutrophil to lymphocyte ratio, and platelet to lymphocyte ratio were independent risk factors for DVT. In particular, neutrophil to lymphocyte ratio and hemoglobin may be used as novel, inexpensive, and reliable diagnostic tools for DVT.Cilj ovoga istraživanja bio je procijeniti parametre kompletne krvne slike (KKS) uključujući eritrocitne indekse, podvrste leukocita i trombocitne pokazatelje za predviđanje duboke venske tromboze (DVT). U istraživanje su bila uključena 44 bolesnika i 27 bolesnica, ukupno njih 71, s akutnom femoralnom i poplitealnom DVT dijagnosticiranom Dopplerovom ultrasonografijom tijekom sedam godina (2011.-2017.) i 142 ispitanika (88 muškaraca i 54 žena) izjednačenih po dobi i spolu te s dijagnozom venske insuficijencije postavljenom u istom razdoblju kao kontrolna skupina. Potrebni podaci za sve ispitanike dobiveni su iz njihovih bolničkih zapisa, uključujući kliničke i demografske karakteristike i parametre KKS. Učestalost hipertenzije, šećerne bolesti, kronične opstruktivne plućne bolesti, kroničnog bubrežnog zatajenja i koronarne arterijske bolesti bila je viša u skupini s DVT u usporedbi sa skupinom bez DVT (p<0,05). Vrijednosti hemoglobina i limfoctia bile su niže, a širina distribucije eritrocita, neutrofil, omjer neutrofila i limfocita te omjer trombocita i limfocita bili su viši u skupini s DVT u usporedbi sa skupinom bez DVT (p<0,05). Nije bilo značajne razlike među skupinama u vrijednostima srednjeg korpuskularnog volumena, trombocita, srednjeg volumena trombocita, omjera srednjeg volumena trombocita i širine distribucije trombocita (p>0,05). Hipertenzija, hemoglobin, omjer neutrofila i limfocita te omjer trombocita i limfocita pokazali su se kao neovisni čimbenici rizika za DVT. Utvrdili smo da su hipertenzija, anemija, omjer neutrofila i limfocita te omjer trombocita i limfocita neovisni čimbenici rizika za DVT. Naročito bi se omjer neutrofila i limfocita te hemoglobin mogli rabiti kao novi, jeftini i pouzdani dijagnostički alati za DVT

Evaluation of paediatric head trauma patients with computed tomography; The requirement of computed tomography in children with head injury: a cross-sectional study

INTRODUCTION: In this study, we aimed to reveal the cranial computed tomography (CT) results of paediatric head trauma cases taken in our hospital and what clinical variables might be related to pathology in cranial CT.   MATERIAL AND METHODS: Age, gender, glasgow coma scale (GCS), open or suspicious skull fracture, vomiting≥ 2, retrograde amnesia ≥ 30 minutes, the detailed mechanism of injury and CT findings (if CT is available)were evaluated.   RESULTS: 66 of the cases were female (35.7%) and 119 were male (64.7%). The ages of the patients vary between 0 and 16 and the average age is 6.76. 108 (58.4%) of the patients had admitted to the hospital with traumas resulted from falling. 33 (17.8%) of them were passengers of a four-wheeled vehicle and 15 (8.1%) were had been crashed with a four-wheeled vehicle.   CONCLUSIONS: In paediatric head traumas, falls and traffic accidents are in the first place and the measures taken in this regard should be increased

EVALUATION OF THE CANADIAN CT HEAD RULE FOR ANALYZING DIAGNOSTIC ACCURACY IN PATIENTS WITH MINOR HEAD TRAUMA

Background: Head computed tomography (CT) scans, which provide reliable information to assessor rule out neurological abnormalities and injuries, should be used judiciously to minimize radiation exposure and cost. Objective: The aim of this study was to evaluate the widely used Canadian CT Head Rule (CCHR) to determine the necessity of head CT scans in patients with minor head trauma. Methods: This retrospective study included 913 patients with head trauma who were admitted to Harakani State Hospital between June 2014 and December 2017. The patient data were reevaluated according to CCHR and compared with the radiological findings. Results: There were a total of 556 patients fulfilling the inclusion criteria with a male/female ratio of 2.95 and a mean age of 37 ± 4.24 years. The most common injury mechanism of head trauma was motor vehicle accidents. Chi square tests were applied for statistical calculations. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of the CCHR were 93%, 88%, 88%, 94%, and 90%, respectively. Conclusion: CCHR was highly useful for patients with minor head trauma who could benefit from head CT evaluation with high sensitivity and specificity

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

An Overview of Animal-Related Injuries

AimThis present study aimed to evaluate a group of patients living in a rural area admitted to emergency room due to animal-relatedinjury and to evaluate this issue from a general point of view.Material and MethodsThe study included 34 patients between the dates April 2015 and April 2017. The injury caused by donkey, horse, and cattle was considered animal-related injury. The demographic features, blood tests, imaging tests, hospitalization status and outcomes of patientswere evaluated retrospectively.ResultsOf the 34 patients, 32(94.1%) were male. The mean age of the patients was 27.56±21.72 (min:5-max:83). The youngest patient wasfive and the oldest one was 83-years-old. Three patients were over 65-years. Eight of the patients (23.5%) were hospitalized. Theaverage hospitalization day of the patients was 4.53±3.46 (min:0-max:10). Acute pathology was detected on cranial tomography sixof the patients (17.6%). None of the patients had pathology on cervical tomography. Acute pathology was detected on thoracictomography five of the patients (14.7%). Acute pathology was detected on abdominal tomography four of the patients (11.8%).ConclusionIn conclusion, people living in rural areas should be informed about animal-related injuries. The arrangements should be made toprevent these injuries in rural areas.KeywordsTrauma; Animal-related injury; Emergency room.</p