Marmara Üniversitesi Tıp Fakültesi Hastanesine başvuran varfarin kullanım öyküsü olan hastalarda, INR değerleriyle komplikasyon gelişim risk ilişkisinin ortaya konması

ÖZETYenidoğanda ağrı ve etkileri konusunda, 1980’den bu yana birçok çalışma yapılmış, böylece ağrı hakkındaki bilgilerimiz artmıştır. Yenidoğanların prosedürel nedenlere bağlı ağrılarının giderilmesinde kullanılan birçok farmakolojik ve nonfarmakolojik yöntemler vardır. Çalışmamızın amacı; sağlıklı yenidoğanların venöz kan alımı sırasında verdikleri ağrı yanıtlarını değerlendirmek ve işlem sırasında kullanılacak olan sukroz ve topikal EMLA uygulamasının ağrıyı azaltmadaki etkilerinin karşılaştırılmasıdır. Bu çalışma; Maltepe Üniversitesi Tıp Fakültesi Yenidoğan Bakım Odasında, Haziran – Temmuz 2009 tarihleri arasında deneysel olarak yapıldı. Çalışma kapsamına toplam 60 bebek alındı. Bunlardan birinci grubu 30 yenidoğandan oluşan %24’lük oral sukroz solüsyonu, işlemden 2 dk önce ve işlemden hemen önce 1’er ml verilen grup, ikinci grubu (n=30) ise %5’lik topikal anestetik (prilocain-lidokain) krem olan EMLA grubu oluşturdu. Bu grupta yenidoğanların işlem alanı üzerine işlemden 60dk önce en fazla 1 gr krem uygulandı ve üzeri şeffaf bir örtü ile örtüldü. Araştırma verileri; yenidoğan doğum özelliklerini, yenidoğan ve ailelerine ilişkin özelliklerini, yenidoğanın işlem öncesi, sırası ve sonrasındaki fiziksel değişikliklerini içermektedir. Yenidoğanların işlem öncesi, sırası ve sonrası ağrı puanlarını saptamak için NIPS(Neonatal Infant Pain Scale) kullanıldı. Her iki grup yenidoğanın fiziksel özellikleri ve ailesel özellikleri açısından homojendir. İşlem öncesi sukroz grubunun NIPS puan ortalaması 0.76 ± 1.86, EMLA grubunun ise 2.56±2.89 olarak belirlendi ve gruplar arasında sukroz grubu lehine anlamlı bir ilişki bulundu. İşlem sırasında, sukroz grubunun NIPS puan ortalaması 1.80 ± 2.49 iken EMLA grubunun 4.10 ± 2.78 olduğu görüldü. Sukroz grubunun NIPS puan ortalaması EMLA grubundan istatistiksel olarak düşük bulundu. İşlem sonrasında sukroz ve EMLA gruplarının NIPS puan ortalamaları sırasıyla 1.36 ± 2.37 ile 2.50 ± 2.96 olarak bulundu ve farkın istatistiksel olarak anlamlı olmadığı görüldü. Her iki grup arasında yenidoğanların, ağrılı işlem öncesi, sırası ve sonrasında; oksijen saturasyonu, kan basıncı ve kalp tepe atımları arasında anlamlı bir fark olmadığı görüldü. Sonuç olarak; sağlıklı yenidoğanlarda %24’lük oral sukroz solüsyonu, %5’lik EMLA topikal kreme göre daha etkili olduğu söylenebilir. Anahtar Kelimeler: Ağrı, EMLA, Sukroz, Venöz yolla kan alma, YenidoğanSUMMARYTHE EFFECTIVENESS OF ORAL SUCROSE AND TOPICAL EMLA APPLICATION IN REDUCING NEONATAL PAIN DURING VENEPUNCTURESince 1980’s, there has been a significant increase in our knowledge of pain in neonates and many clinical trials have been published. Many pharmacological and no pharmacological methods are currently available to reduce the procedural pain in neonates. The aim of our study is to determine the pain responses of healthy neonates during venepuncture and to compare the effectiveness of oral sucrose and topical EMLA application in reducing neonatal pain. This study was performed between June 2009 and July 2009 at the Maltepe University, Medical Faculty Neonatal Care Unit. Our study included 60 healthy neonates. In the first group consisted of 30 neonates, oral sucrose (concentration 24%) was used in oral doses in the order of 1mls of 24% sucrose in commencing 2 minutes before and just before the procedure. In the second group (n=30), lidocaine-prilocaine 5% cream (EMLA) which is a topical anesthetic, was applied (1g) to puncture site and covered with occlusive dressing, 60 minutes prior to venepuncture. Data collecting questionnaire included the birth characteristics of neonates, demographical features of parents and the physical changes observed in subjects before, during and after the procedure. To determine the pain score in neonates before, during end after he procedure, Neonatal Infant Pain Scale (NIPS) was used. There were no significant differences in birth characteristics between groups. Before the venepuncture; sucrose-treated infants had lower NIPS scores than EMLA applied neonates (0.76±2.89 and 2.56±2.89, respectively). During the procedure, NIPS scores of sucrose treated group was statistically lower than that of EMLA applied group (1.80±2.49 and 4.10±2.78, respectively). After the procedure there was no significant difference in NIPS scores between groups (1.36±2.37 and 2.50±2.96, respectively).There were no significant differences in oxygen saturation, blood pressure and heart rate between groups; before, during and after the procedure. In conclusion; in our study we found that oral sucrose (concentration 24%) solution is more effective than the local anesthetic cream EMLA in reducing pain from venepuncture in healthy newborns.Key words: Pain, EMLA, Sucrose, Venepuncture, Neonat

Marmara Üniversitesi Tıp Fakültesi Hastanesine başvuran varfarin kullanım öyküsü olan hastalarda, INR değerleriyle komplikasyon gelişim risk ilişkisinin ortaya konması

ÖZETYenidoğanda ağrı ve etkileri konusunda, 1980’den bu yana birçok çalışma yapılmış, böylece ağrı hakkındaki bilgilerimiz artmıştır. Yenidoğanların prosedürel nedenlere bağlı ağrılarının giderilmesinde kullanılan birçok farmakolojik ve nonfarmakolojik yöntemler vardır. Çalışmamızın amacı; sağlıklı yenidoğanların venöz kan alımı sırasında verdikleri ağrı yanıtlarını değerlendirmek ve işlem sırasında kullanılacak olan sukroz ve topikal EMLA uygulamasının ağrıyı azaltmadaki etkilerinin karşılaştırılmasıdır. Bu çalışma; Maltepe Üniversitesi Tıp Fakültesi Yenidoğan Bakım Odasında, Haziran – Temmuz 2009 tarihleri arasında deneysel olarak yapıldı. Çalışma kapsamına toplam 60 bebek alındı. Bunlardan birinci grubu 30 yenidoğandan oluşan %24’lük oral sukroz solüsyonu, işlemden 2 dk önce ve işlemden hemen önce 1’er ml verilen grup, ikinci grubu (n=30) ise %5’lik topikal anestetik (prilocain-lidokain) krem olan EMLA grubu oluşturdu. Bu grupta yenidoğanların işlem alanı üzerine işlemden 60dk önce en fazla 1 gr krem uygulandı ve üzeri şeffaf bir örtü ile örtüldü. Araştırma verileri; yenidoğan doğum özelliklerini, yenidoğan ve ailelerine ilişkin özelliklerini, yenidoğanın işlem öncesi, sırası ve sonrasındaki fiziksel değişikliklerini içermektedir. Yenidoğanların işlem öncesi, sırası ve sonrası ağrı puanlarını saptamak için NIPS(Neonatal Infant Pain Scale) kullanıldı. Her iki grup yenidoğanın fiziksel özellikleri ve ailesel özellikleri açısından homojendir. İşlem öncesi sukroz grubunun NIPS puan ortalaması 0.76 ± 1.86, EMLA grubunun ise 2.56±2.89 olarak belirlendi ve gruplar arasında sukroz grubu lehine anlamlı bir ilişki bulundu. İşlem sırasında, sukroz grubunun NIPS puan ortalaması 1.80 ± 2.49 iken EMLA grubunun 4.10 ± 2.78 olduğu görüldü. Sukroz grubunun NIPS puan ortalaması EMLA grubundan istatistiksel olarak düşük bulundu. İşlem sonrasında sukroz ve EMLA gruplarının NIPS puan ortalamaları sırasıyla 1.36 ± 2.37 ile 2.50 ± 2.96 olarak bulundu ve farkın istatistiksel olarak anlamlı olmadığı görüldü. Her iki grup arasında yenidoğanların, ağrılı işlem öncesi, sırası ve sonrasında; oksijen saturasyonu, kan basıncı ve kalp tepe atımları arasında anlamlı bir fark olmadığı görüldü. Sonuç olarak; sağlıklı yenidoğanlarda %24’lük oral sukroz solüsyonu, %5’lik EMLA topikal kreme göre daha etkili olduğu söylenebilir. Anahtar Kelimeler: Ağrı, EMLA, Sukroz, Venöz yolla kan alma, YenidoğanSUMMARYTHE EFFECTIVENESS OF ORAL SUCROSE AND TOPICAL EMLA APPLICATION IN REDUCING NEONATAL PAIN DURING VENEPUNCTURESince 1980’s, there has been a significant increase in our knowledge of pain in neonates and many clinical trials have been published. Many pharmacological and no pharmacological methods are currently available to reduce the procedural pain in neonates. The aim of our study is to determine the pain responses of healthy neonates during venepuncture and to compare the effectiveness of oral sucrose and topical EMLA application in reducing neonatal pain. This study was performed between June 2009 and July 2009 at the Maltepe University, Medical Faculty Neonatal Care Unit. Our study included 60 healthy neonates. In the first group consisted of 30 neonates, oral sucrose (concentration 24%) was used in oral doses in the order of 1mls of 24% sucrose in commencing 2 minutes before and just before the procedure. In the second group (n=30), lidocaine-prilocaine 5% cream (EMLA) which is a topical anesthetic, was applied (1g) to puncture site and covered with occlusive dressing, 60 minutes prior to venepuncture. Data collecting questionnaire included the birth characteristics of neonates, demographical features of parents and the physical changes observed in subjects before, during and after the procedure. To determine the pain score in neonates before, during end after he procedure, Neonatal Infant Pain Scale (NIPS) was used. There were no significant differences in birth characteristics between groups. Before the venepuncture; sucrose-treated infants had lower NIPS scores than EMLA applied neonates (0.76±2.89 and 2.56±2.89, respectively). During the procedure, NIPS scores of sucrose treated group was statistically lower than that of EMLA applied group (1.80±2.49 and 4.10±2.78, respectively). After the procedure there was no significant difference in NIPS scores between groups (1.36±2.37 and 2.50±2.96, respectively).There were no significant differences in oxygen saturation, blood pressure and heart rate between groups; before, during and after the procedure. In conclusion; in our study we found that oral sucrose (concentration 24%) solution is more effective than the local anesthetic cream EMLA in reducing pain from venepuncture in healthy newborns.Key words: Pain, EMLA, Sucrose, Venepuncture, Neonat

Diagnostic and prognostic values of cerebral oxygen saturations measured by INVOS™ in patients with ischemic and hemorrhagic cerebrovascular disease

Objectives: In this study it was aimed to investigate whether measurement of potential changes of cerebral oxygenation saturations due to ischemic or hemorrhagic cerebrovascular diseases have an early diagnostic and prognostic value. Methods: Adult patients (≥18 years old) having acute ischemic or hemorrhagic stroke were included in the study. Patients under 18-year-old, those with incomplete data or suspicious diagnosis were excluded.The cerebral oxygen saturations of the patients were compared with the healthy subjects. Patients were also grouped according to their clinical outcomes; good clinical status (group 1) and poor clinical status (group 2). These groups were compared according to the patients’ cerebral oxygen saturations. Results: The mean oxygen saturation of the patients and healthy people were similar (59.48% ± 10.6 versus 58.44% ± 9.6). There was no difference between patients and healthy population according to cerebral oxygen saturations. Furthermore, mean oxygen levels were also similar between the hemisphere without lesion and with lesion in the patients group (59.8% ± 11.8 versus 59.2% ± 10.4).When the patients were grouped according to their clinical status, there were 30 patients in group 1 and 15 in group 2. The cerebral oxygen saturations of the hemisphere with lesion were similar between these groups and no statistical difference was observed (59.2% ± 9.3 versus 59.1% ± 12.6, p = 0.9). There was also no statistical difference between the groups when delta oxygen levels of the affected and unaffected hemispheres of the groups were calculated (0.9% ± 6.1 versus 0.13% ± 8.4, p = 0.7). Conclusion: Results of this study revealed that there was no difference in cerebral oxygen saturations measured by near-infrared cerebral oximetry system between the patients with cerebrovascular disease and healthy population. Furthermore, our results did not support that the cerebral oxygen saturations may be used for determining the prognosis of the patients with cerebrovascular disease. Keywords: Stroke, Cerebrovascular disorders, Diagnosis, Diagnosis emergency departmen

Occipital epidermoid cyst of furuncular myiasis presenting with spontaneous bleeding: a case report.

A 77-year-old female patient was presented to the emergency department with swelling and bleeding in the occiput. It was learned from the patient that the soft tissue swelling on her head had been present for 1 year, and she had no history of trauma. The patient had diabetes mellitus and hypertension and a history of breast cancer 15 years ago. An epidermoid cyst, approximately 5x5 centimeter in size, bleeding in the form of leakage was observed on the patient's occipital scalp. There was no intracranial pathology in the brain computerized tomography. Wound debridement revealed that the cyst contained approximately 30 live larvae. All larvae were cleaned from the tissue defect. When looking from the outside, the larvae were 8-12 millimeters in size, yellow-white, spiral in shape, and were thought to be compatible with the larva of Lucilia sericata diptera. Myiasis is an ectoparasitic infection of diptera larvae by settling in human and animal tissues. When flies leave their larvae in the tissue, the larvae that invade and develop in that area cause infection. Cutaneous myiasis is the most common clinical form and can be seen on the scalp and cause furuncular myiasis. Immunosuppression, lack of self-care, travel to endemic areas and trauma have been reported as risk factors for myiasis. It was thought that the history of diabetes and old malignancy might be predisposing in our patient. In this case report, it is aimed to present a case of furuncular myiasis that settled down without any trauma to the occiput and presented with spontaneous soft tissue bleeding

Effect of the prognostic nutritional index and systemic immuneinflammatory index in predicting short-term mortality in geriatric patients with SARS-CoV-2 infection

Introduction and aim. We aimed to investigate whether systemic immune inflammatory index (SII) and prognostic nutritional index (PNI) were associated with short-term mortality in geriatric patients with SARS-CoV-2.Material and methods. Our study was designed retrospectively. The data of patients that presented to a single center. The primary outcome of the study was the diagnostic value of SII and PNI in predicting 28-day mortality in geriatric patients with SARS-CoV-2 pneumonia. Results. 272 geriatric patients with SARS-CoV-2 included. The median PNI was 42.5, and the median SII was 687.6 (430–1404.2). In univariant analysis, PNI and SII has a significant relationship with mortality (p40.1) and SII (<1.267) for 30-day mortality were determined as 1.12 , and 1. Conclusion. In conclusion, the blood tests used to calculate PNI and SII are routinely included in complete blood count and biochemistry tests that can be performed in every hospital. According to the results of the current study, the mortality group had significantly higher SII values and significantly lower

Ischemic Stroke after Head Trauma in a Child: case report

Pediatric traumas are an important cause of morbidity and mortality. Symptoms in children may differ from those in adult patients. Although the findings of physical examinations and imaging may be normal in the early posttraumatic period, patients may develop various symptoms and signs in the late term. Herein, we present the case of an 11 year old boy who had normal physical examination and imaging findings in the early posttraumatic period, but who later presented with severe headache and was found to have cerebral infarct, and make a review of related literature

Predictive ability of the MEWS, REMS, and RAPS in geriatric patients with SARS-CoV-2 infection in the emergency department

To compare the ability of the Modified Early Warning Score (MEWS), Rapid Emergency Medicine Score (REMS), and Rapid Acute Physiology Score (RAPS) to predict 30 day-mortality in patients with SARS-CoV-2 infection aged 65 years and over. Methods: This prospective, single-center, observational study was carried out with 122 volunteers aged 65 years and over with patients confirmed to have SARS-CoV-2 infection according to the RT-PCR test, who presented to the emergency department between March 1, 2020 and May 1, 2020. Demographic data, comorbidities, vital parameters, hematological parameters, and MEWS, REMS and RAPS values of the patients were recorded prospectively. Results: Among the 122 patients included in the study, the median age was 71 (25th-75th quartile: 67-79) years. The rate of 30-day mortality was 10.7% for the study cohort. The area under the receiver operating characteristic curve values for MEWS, RAPS and REMS were 0.512 [95% confidence interval (CI): 0.420-0.604, p = 0.910], 0.500 (95% CI: 0.408-0.592, p = 0.996), and 0.675 (95% CI: 0.585-0.757, p = 0.014), respectively. The odds ratios of MEWS (≥2), RAPS (>2) and REMS (>5) for 30-day mortality were 0.374 (95% CI: 0.089-1.568, p = 0.179), 1.696 (95% CI: 0.090-31.815, p = 0.724), and 1.008 (95% CI: 0.257-3.948, p = 0.991), respectively. Conclusion: REMS, RAPS and MEWS do not seem to be useful in predicting 30-day mortality in geriatric patients with SARS-CoV-2 infection presenting to the emergency departmen

The role of the hematological inflammatory index and systemic immuno-inflammation index in acute cholecystitis

Introduction and aim. Acute cholecystitis is one of the most common hepatobiliary emergencies. We aimed to investigate the role of the initial hematological inflammatory index and systemic immuno-inflammation index in predicting short-term mortality in patients with acute cholecystitis. Material and methods. This study with a retrospective observational design was conducted at the emergency department of a tertiary teaching hospital. Patients admitted to our clinic between June 15, 2021, and March 15, 2022, according to the Tokyo criteria were included in the sample. The hematological inflammatory index and systemic immuno-inflammation index were calculated using the hematological test results of the patients evaluated at the emergency department. Survivor and non-survivor groups were formed according to all-cause 30-day mortality. The differences between survivor and non-survivor groups were investigated. Results. A total of 194 patients were included in the final analysis. The median age of the study population was 59 (25th–75th percentiles: 46.75–72) years. The rate of all cause-short-term mortality was 7.7. There were significant differences between the survivor and non-survivor groups in terms of the neutrophil count and the systemic immuno-inflammation index (p=0.007, 0.034, respectively; Mann-Whitney U test). No significant difference was found in the remaining laboratory parameters (lymphocyte count, platelet count, and hematological inflammatory index) (p=0.220, 0.489, 0.367 respectively; Mann-Whitney U test). Conclusion. The systemic immuno-inflammation index was determined to be significantly higher in the non-survivor group than in the survivor group among the patients with acute cholecystitis. However, there was no significant difference between these two groups in relation to the hematological inflammatory inde