Comparison of recovery criteria following anaesthesia with sevoflurane and isoflurane in geriatric patients

Amaç: Bu çalışmada, geriyatrik hastalarda volatil anesteziklerden sevofluran ve isofluranın derlenme kriterleri üzerine etkileri karşılaştırıldı. Çalışma Planı: Elektif ürolojik ve jinekolojik cerrahi girişim planlanan ASA I-II grubundan 65 yaş ve üzeri 40 hasta rastgele eşit sayıda iki gruba ayrıldı. Tüm olguların premedikasyonu intramusküler 0.06 mgkg-1 midazolam, anestezi indüksiyonu intravenöz 1.5 mgkg-1 propofol, 0.6 mgkg-1 atrakuryum besilat ve 500 ?g alfentanil ile gerçekleştirildi. Anestezi idamesi grup I’de 1 MAC isofluran, grup II’de 1 MAC sevofluran ve gerektikçe intravenöz 0.1 mgkg-1 atrakurium ile sürdürüldü. Ameliyat sonunda her iki grupta da derlenme kriterleri olarak belirlenen spontan göz açma, ekstübasyon, sözel yanıt ve oryantasyon süreleri kaydedildi. Bulgular: Sevofluran grubunda, isofluran grubuna göre spontan göz açma (p=0.0002), ekstübasyon (p=0.0002), sözel yanıt (p=0.0001) ve oryantasyon (p=0.0001) süreleri anlamlı derecede kısa bulundu. Sonuç: Geriyatrik olgularda sevofluranın derlenme kriterleri açısından isoflurana göre daha avantajlı olduğu kanısına varıldı.Objectives: The aim of this study was to compare the effects of volatile anesthetics, sevoflurane and isoflurane, on recovery criteria in geriatric patients. Study Design: Forty ASA I-II patients at the age of 65 years or above, who were planned for elective urological or gynecological operation were randomized to two groups equal in number. Each group received 0.06 mgkg-1 intramuscular midazolam for premedication, and intravenous 1.5 mgkg-1 propofol, 0.6 mgkg-1 atracurium besylate, and 500 µg alfentanil for induction. Anesthesia was maintained with approximately 1 MAC isoflurane in group I, and 1 MAC sevoflurane in group II, and, when necessary, intravenous 0.1 mgkg-1 atracurium. Recovery criteria included spontaneous eye opening, extubation, verbal response, and orientation times at the end of operation. Results: Compared to the isoflurane group, durations of spontaneous eye opening (p=0.0002), extubation (p=0.0002), verbal response (p=0.0001), and orientation (p=0.0001) were significantly shorter in the sevoflurane group. Conclusion: We concluded that sevoflurane anesthesia is more advantegous over isoflurane in geriatric patients

Dobrava Hantavirus Infection Complicated by Panhypopituitarism, Istanbul, Turkey, 2010

We identified Dobrava-Belgrade virus infection in Turkey (from a strain related to hantavirus strains from nearby countries) in a patient who had severe symptoms leading to panhypopituitarism, but no known risk for hantavirus. Our findings emphasize the need for increased awareness of hantaviruses in the region and assessment of symptomatic persons without known risk factors for infection

Recent Advances in Health Biotechnology During Pandemic

The outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which emerged in 2019, cut the epoch that will make profound fluctuates in the history of the world in social, economic, and scientific fields. Urgent needs in public health have brought with them innovative approaches, including diagnosis, prevention, and treatment. To exceed the coronavirus disease 2019 (COVID-19) pandemic, various scientific authorities in the world have procreated advances in real time polymerase chain reaction (RT-PCR) based diagnostic tests, rapid diagnostic kits, the development of vaccines for immunization, and the purposing pharmaceuticals for treatment. Diagnosis, treatment, and immunization approaches put for- ward by scientific communities are cross-fed from the accrued knowledge of multidisciplinary sciences in health biotechnology. So much so that the pandemic, urgently prioritized in the world, is not only viral infections but also has been the pulsion in the development of novel approaches in many fields such as diagnosis, treatment, translational medicine, virology, mi- crobiology, immunology, functional nano- and bio-materials, bioinformatics, molecular biol- ogy, genetics, tissue engineering, biomedical devices, and artificial intelligence technologies. In this review, the effects of the COVID-19 pandemic on the development of various scientific areas of health biotechnology are discussed

Sciatic nerve localization relative to the position of the hip, an anatomical study.

The incidence of iatrogenic peripheral nerve injury during hip arthroplasty procedures has been reported to be between 0.6 and 1.3 percent. The relative risk of nerve palsy is higher in certain groups of patients such as women, patients with developmental dysplasia of the hip, and those who have undergone revision arthroplasty. In this study, the dynamic relationship between the acetabulum and the sciatic nerve, which is important for preventing sciatic nerve palsy during the hip surgery, was investigated. The sciatic nerve was exposed in 69 cadaveric hips. The relationship between the bony acetabulum and the sciatic nerve was examined in three different positions; as the ipsilateral hip was flexed; extended; or in neutral position. We found that the middle part of the posterior acetabular rim was closer to the sciatic nerve than its superior or inferior parts. The sciatic nerve was perilous when the ipsilateral hip was flexed and the middle part of the posterior acetabular rim was more risky than the superior or inferior parts, in terms of iatrogenic sciatic nerve injury

Gastrostomy in hospitalized patients with acute stroke: "NoroTek" Turkey point prevalence study subgroup analysis

Objective: Nutritional status assessment, dysphagia evaluation and enteral feeding decision are important determinants of prognosis in acute neurovascular diseases. Materials and Methods: NöroTek is a point prevalence study conducted with the participation of 87 hospitals spread across all health sub regions of Turkey conducted on 10-May-2018 (World Stroke Awareness Day). A total of 972 hospitalized neurovascular patients [female: 53%, age: 69±14; acute ischemic stroke in 845; intracerebral hematoma (ICH) in 119 and post-resuscitation encephalopathy (PRE) in 8] with complete data were included in this sub-study. Results: Gastrostomy was inserted in 10.7% of the patients with ischemic stroke, 10.1% of the patients with ICH and in 50% of the patients with PRE. Independent predictors of percutaneous endoscopic gastrostomy (PEG) administration were The National Institutes of Health Stroke Scale score at admission [exp (β): 1.09 95% confidence interval (CI): 1.05-1.14, per point] in ischemic stroke; and mechanical ventilation in ischemic [exp (β): 6.18 (95% CI: 3.16-12.09)] and hemorrhagic strokes [exp (β): 26.48 (95% CI: 1.36-515.8)]. PEG was found to be a significant negative indicator of favorable (modified Rankin’s scale score 0-2) functional outcome [exp (β): 0.032 (95% CI: 0.004-0.251)] but not of in-hospital mortality [exp (β): 1.731 (95% CI: 0.785-3.829)]. Nutritional and swallowing assessments were performed in approximately two-thirds of patients. Of the nutritional assessments 69% and 76% of dysphagia assessments were completed within the first 2 days. Tube feeding was performed in 39% of the patients. In 83.5% of them, tube was inserted in the first 2 days; 28% of the patients with feeding tube had PEG later. Conclusion: The NöroTek study provided the first reliable and large-scale data on key quality metrics of nutrition practice in acute stroke in Turkey. In terms of being economical and accurate it makes sense to use the point prevalence method.Amaç: Akut nörovasküler hastalıklarda nütrisyonel durum ve disfaji değerlendirmesi ve enteral beslenme kararı önemli prognoz belirleyicilerindendir. Gereç ve Yöntem: NöroTek, 10 Mayıs 2018’de (Dünya İnme Farkındalık Günü) Türkiye’nin tüm sağlık alt bölgelerine yayılmış 87 hastanenin katılımıyla gerçekleştirilen bir nokta prevalans çalışmasıdır. Hastanede yatan ve bu alt çalışma için toplanan verisi tam olan toplam 972 nörovasküler hasta (kadın: %53, yaş: 69±14 yıl; 845’i akut iskemik inme; 119’u intraserebral hematom ve 8’i post-resüsitasyon ensefalopatisi) analiz edildi. Bulgular: Gastrostomi iskemik inmeli hastaların %10,7, intraserebral kanamalıların %10,1 ve post-resusitasyon ensefalopatisi olanların %50’sine uygulanmıştır. Perkütan endoskopik gastrostomi (PEG) gereksiniminin bağımsız belirleyicileri, iskemik inme grubunda kabul NIHSS [exp (β): 1,09, %95 güven aralığı (GA): 1,05-1,14, puan başına] ile hem iskemik hem de hemorajik inmelerde mekanik ventilasyon uygulanmış olmasıdır [iskemik için: exp (β): 6,18, %95 GA: 3,16- 12,09] ve hemorajik inme için: [exp (β): 26,48, 95% GA: 1,36-515,8]. İnme olgularında PEG uygulaması hastane içi mortalite için bağımsız belirleyici değildi [exp (β): 1,731, 95% GA: 0,785-3,829]. Ancak, PEG uygulanmış olması taburculuk esnasında iyi prognoza (modifiye Rankin skoru 0-2) sahip olabilme için anlamlı bir negatif etmen olarak bulundu [exp (β): 0,032, %95 GA: 0,004-0,251]. Hastanede yatan nörovasküler hastaların yaklaşık üçte ikisinde malnütrisyon ve yutma bozukluğu açısından değerlendirme yapılmıştı. Nutrisyonel status değerlendirmesinin %69’u ve disfaji değerlendirmesinin %76’sı ilk 48 saat içinde gerçekleştirilmişti. Tüple enteral nütrisyon uygulama oranı %39’du. Beslenme tüplerinin %83,5’i ilk 2 gün içinde yerleştirilirken beslenme tüpü olan hastaların %28’ine daha sonra PEG açılmıştı. Sonuç: NöroTek çalışması ile Türkiye’de hastanede yatan akut inme hastalarında nutrisyonel uygulamaların temel kalite ölçütlerine ilişkin ilk güvenilir ve büyük ölçekli veri sağlanmıştır. Ekonomik olması ve doğruluğu açısından nokta yaygınlık yönteminin bu tip verilerin temini için daha fazla kullanılması mantıklıdır